Provider Demographics
NPI:1427687698
Name:CCDLD,INC
Entity type:Organization
Organization Name:CCDLD,INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INCORPORATOR/ORGANIZER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:HAYS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:501-590-3926
Mailing Address - Street 1:18 FARNHAM LOOP
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72223-9199
Mailing Address - Country:US
Mailing Address - Phone:501-590-3926
Mailing Address - Fax:
Practice Address - Street 1:18 FARNHAM LOOP
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72223-9199
Practice Address - Country:US
Practice Address - Phone:501-590-3926
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-08
Last Update Date:2020-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies