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General NPI Number Information
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NPI Number | 1639380231
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Entity Type | Organization
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Legal Business Name | KELS ADULT DAY HEALTHCARE
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Dates
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Enumeration Date | 05/24/2007
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Last Update Date | 08/10/2007
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Provider Practice Location Address
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Address Line | 601 N 1ST ST SUITE 4 & 5
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City | JACKSONVILLE
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State | AR
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Zip | 72076-4117
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Country | US
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Telephone | 501-241-0008
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 2095
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City | CONWAY
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State | AR
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Zip | 72033-2095
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PROGRAM DIRECTOR
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Name | KIMBERLY LASKER
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Credential |
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Telephone | 501-241-0008
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number |
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License Number State | AR
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Taxonomy #2
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number |
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License Number State | AR
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Taxonomy #3
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Taxonomy Code | 261QA0600X
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Taxonomy Name | Adult Day Care Clinic/Center
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License Number |
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License Number State | AR
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Taxonomy #4
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Taxonomy Code | 385H00000X
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Taxonomy Name | Respite Care
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License Number |
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License Number State | AR
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Taxonomy #5
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Taxonomy Code | 261QA0600X
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Taxonomy Name | Adult Day Care Clinic/Center
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License Number |
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License Number State | AR
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