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NPI Code Detail

MEDICARE: CREATIVE HOUSING III-MT HOLLY

MEDICARE: CREATIVE HOUSING III-MT HOLLY
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1315P00000XIntellectual Disabilities Intermediate Care Facility

General Provider Information

NPI Number : 1952427569
Entity Type Code : Organization
Provider Name (Legal Business Name) : CREATIVE HOUSING III-MT HOLLY
Provider Business Mailing Address
First Line : 714 W GROVE ST
Second Line :
City : EL DORADO
State : AR
Zip : 71730-4416
Country : US
Telephone Number : 870-863-8194
Fax Number : 870-881-4600
Provider Business Practice Location Address
First Line : 1215 MOUNT HOLLY RD
Second Line :
City : EL DORADO
State : AR
Zip : 71730-4236
Country : US
Telephone Number : 870-863-8194
Fax Number : 870-881-4600
Authorized Official
Title or Position : BUSINESS MANAGER
Name : BARBARA STAGGS
Credential :
Telephone Number : 870-863-8194
Provider Enumeration Date : 03/22/2007
Last Update Date : 08/22/2020

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Directions to “CREATIVE HOUSING III-MT HOLLY ” Practice Location

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