Provider Demographics
NPI:1477679074
Name:CREATIVE HOUSING III-NEWTON
Entity Type:Organization
Organization Name:CREATIVE HOUSING III-NEWTON
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:
Authorized Official - Last Name:STAGGS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:870-863-8194
Mailing Address - Street 1:714 W GROVE ST
Mailing Address - Street 2:
Mailing Address - City:EL DORADO
Mailing Address - State:AR
Mailing Address - Zip Code:71730-4416
Mailing Address - Country:US
Mailing Address - Phone:870-863-8194
Mailing Address - Fax:870-881-4600
Practice Address - Street 1:232 N NEWTON AVE
Practice Address - Street 2:
Practice Address - City:EL DORADO
Practice Address - State:AR
Practice Address - Zip Code:71730-5422
Practice Address - Country:US
Practice Address - Phone:870-863-8194
Practice Address - Fax:870-881-4600
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes315P00000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Intellectual Disabilities