Organization
KREEATIVE DEVELOPMENTAL DISABILITY SERVICES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. RANIESHA PARKER (CEO, PRESIDENT)
(501) 472-8352
Entity
Organization
Contact information
Practice address
111 CHICKASAW PL, JACKSONVILLE, AR 72076-1905
(501) 472-8352
Mailing address
111 CHICKASAW PL, JACKSONVILLE, AR 72076-1905
(501) 472-8352
Taxonomy
Speciality
Code
Description
License number
State
253Z00000X
In Home Supportive Care Agency
Primary
—
—
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
—
—
Other
Enumeration date
06/04/2024
Last updated
06/04/2024
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