Organization
COMMUNITY LIVING ARRANGEMENTS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. BARBARA STAGGS (CFO)
(870) 904-8499
Entity
Organization
Contact information
Practice address
714 W GROVE ST, EL DORADO, AR 71730-4416
(870) 863-8194
Mailing address
714 W GROVE ST, EL DORADO, AR 71730-4416
(870) 863-8194
Taxonomy
Speciality
Code
Description
License number
State
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
131009767
—
AR
Enumeration date
06/16/2020
Last updated
06/16/2020
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