Healthcare Provider Details

I. General information

NPI: 1740129352
Provider Name (Legal Business Name): KECIS LEE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/27/2026
Last Update Date: 03/27/2026
Certification Date: 03/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2115 CEDAR RDG
BENTON AR
72015-2571
US

IV. Provider business mailing address

2115 CEDAR RDG
BENTON AR
72015-2571
US

V. Phone/Fax

Practice location:
  • Phone: 501-346-6006
  • Fax:
Mailing address:
  • Phone: 501-346-6006
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: MS. KECIS D LEE
Title or Position: OWNER
Credential:
Phone: 501-346-6006