Provalsd Clarksville

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

Legal business name

PROVALSD CLARKSVILLE

Doing business as

Providence Assisted Living Clarksville

Practice address

702 S Hospital Dr
Clarksville, AR 72830-4434

Phone

(479) 747-6696

Fax

(479) 747-6696

NPI assigned

Apr 17, 2026

Organization subpart

No

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

Authorized official

Name

Malissa Ellis, ELLIS

Title

Director of Operations

Phone

(501) 472-9070

Specialties & licenses 1

Addresses

Other names 1

• Providence Assisted Living Clarksville Doing business as

Locations

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

{
    "created_epoch": "1776384000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1776384000000",
    "number": "1811831068",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "702 S HOSPITAL DR",
            "city": "CLARKSVILLE",
            "state": "AR",
            "postal_code": "728304434",
            "telephone_number": "479-747-6696",
            "fax_number": "479-747-6696"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "702 S HOSPITAL DR",
            "city": "CLARKSVILLE",
            "state": "AR",
            "postal_code": "728304434",
            "telephone_number": "479-747-6696",
            "fax_number": "479-747-6696"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROVALSD CLARKSVILLE",
        "organizational_subpart": "NO",
        "enumeration_date": "2026-04-17",
        "last_updated": "2026-04-17",
        "certification_date": "2026-04-17",
        "status": "A",
        "authorized_official_last_name": "ELLIS",
        "authorized_official_first_name": "MALISSA",
        "authorized_official_title_or_position": "DIRECTOR OF OPERATIONS",
        "authorized_official_telephone_number": "501-472-9070",
        "authorized_official_credential": "ELLIS"
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Providence Assisted Living Clarksville",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Latoyya Machelle Prince
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• Amber Randeau
• Brian Randeau
• Kaitlin Ratsphangthong
• Candice Reado

• Assisted Living Facility in Clarksville, AR
• Providers in Clarksville, AR by specialty
• Assisted Living Facility in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 17, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.