NPIMap

Organization Active NPI

Creative Housing III-Newton

  • Intellectual Disabilities Intermediate Care Facility
  • El Dorado, AR
National Provider Identifier
1477679074
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Intellectual Disabilities Intermediate Care FacilityTaxonomy code 315P00000X
Legal business name
CREATIVE HOUSING III-NEWTON
Practice address
232 N Newton Ave
El Dorado, AR 71730-5422
Phone
(870) 863-8194
Fax
(870) 881-4600
NPI assigned
Mar 22, 2007
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mrs. Barbara Staggs
Title
Business Manager
Phone
(870) 863-8194

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Intellectual Disabilities Intermediate Care Facility 315P00000X NU Primary

Addresses

Primary practice location

232 N Newton Ave
El Dorado, AR 71730-5422

Mailing address

714 W Grove St
El Dorado, AR 71730-4416
Phone (870) 863-8194

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1477679074. Details of each certification follow.

  • CCN 04G021 Intermediate care facility for individuals with intellectual disabilities · Active · Name & address match · Details

Intermediate care facility for individuals with intellectual disabilities certification: CCN 04G021

Name & address match This certification has no NPI in the Medicare enrollment files. CMS publishes enrollment files for six facility types only, so it was connected to this NPI by matching the name and address CMS publishes for it.

Legal name
CREATIVE HOUSING, I I I - NEWTON
Certification status
Active
Provider type (POS)
Intermediate care facility for individuals with intellectual disabilities
Participating since
Apr 20, 1990
Last certification
Nov 20, 2025
Beds
10
Ownership / control type
Private (non-profit)
Facility address
232 Newton St
El Dorado, AR 71730

National Provider Directory

National Provider Directory
Tax ID family
Creative Housing III-Mt Holly2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

232 N Newton Ave
El Dorado, AR 71730
Phone (870) 863-8194

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1174521600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1477679074",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "714 W GROVE ST",
            "city": "EL DORADO",
            "state": "AR",
            "postal_code": "717304416",
            "telephone_number": "870-863-8194",
            "fax_number": "870-881-4600"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "232 N NEWTON AVE",
            "city": "EL DORADO",
            "state": "AR",
            "postal_code": "717305422",
            "telephone_number": "870-863-8194",
            "fax_number": "870-881-4600"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CREATIVE HOUSING III-NEWTON",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-22",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "STAGGS",
        "authorized_official_first_name": "BARBARA",
        "authorized_official_title_or_position": "BUSINESS MANAGER",
        "authorized_official_telephone_number": "870-863-8194",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "315P00000X",
            "taxonomy_group": "",
            "desc": "Intermediate Care Facility, Intellectual Disabilities",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in El Dorado, AR

Sources for this page

Verify at the official NPI Registry.