Provider Demographics
NPI:1639380231
Name:KELS ADULT DAY HEALTHCARE
Entity type:Organization
Organization Name:KELS ADULT DAY HEALTHCARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:
Authorized Official - Last Name:LASKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:501-241-0008
Mailing Address - Street 1:PO BOX 2095
Mailing Address - Street 2:
Mailing Address - City:CONWAY
Mailing Address - State:AR
Mailing Address - Zip Code:72033-2095
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:601 N 1ST ST
Practice Address - Street 2:SUITE 4 & 5
Practice Address - City:JACKSONVILLE
Practice Address - State:AR
Practice Address - Zip Code:72076-4117
Practice Address - Country:US
Practice Address - Phone:501-241-0008
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-24
Last Update Date:2007-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR251B00000X, 251E00000X, 261QA0600X, 385H00000X, 261QA0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
No251B00000XAgenciesCase Management
No251E00000XAgenciesHome Health
No385H00000XRespite Care FacilityRespite Care