Healthcare Provider Details

I. General information

NPI: 1780577841
Provider Name (Legal Business Name): ALPHA LED LIVING SERVICES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/29/2025
Last Update Date: 03/31/2026
Certification Date: 03/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

140 MUNICIPAL DR
JACKSONVILLE AR
72076-4274
US

IV. Provider business mailing address

7605 GERONIMO CIR
NORTH LITTLE ROCK AR
72116-4317
US

V. Phone/Fax

Practice location:
  • Phone: 501-902-8715
  • Fax: 501-232-8549
Mailing address:
  • Phone: 501-710-4772
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: CECILIA BAKER
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 501-710-4772