Organization
INDEPENDENT LIVING SERVICES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JACKIE FLISS (DIRECTOR)
(501) 327-5234
Entity
Organization
Contact information
Practice address
1105 DEER ST STE 9, CONWAY, AR 72032-5450
(501) 327-5883
Mailing address
1105 DEER ST STE 9, CONWAY, AR 72032-5450
(501) 327-5883
Taxonomy
Speciality
Code
Description
License number
State
251C00000X
Developmentally Disabled Services Day Training Agency
Primary
OTR-1868
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
152002721
—
AR
Enumeration date
11/04/2008
Last updated
11/04/2008
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