Healthcare Provider Details

I. General information

NPI: 1942297411
Provider Name (Legal Business Name): KMJ ENTERPRISES SKILL CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/30/2005
Last Update Date: 06/10/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2911 BROWNS LN
JONESBORO AR
72401-7204
US

IV. Provider business mailing address

2911 BROWNS LN
JONESBORO AR
72401-7204
US

V. Phone/Fax

Practice location:
  • Phone: 870-935-8330
  • Fax: 870-935-8332
Mailing address:
  • Phone: 870-935-8330
  • Fax: 870-935-8332

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number708
License Number StateAR

VIII. Authorized Official

Name: PATRICIA MILLER
Title or Position: PRESIDENT/CEO
Credential:
Phone: 479-636-5716