Healthcare Provider Details

I. General information

NPI: 1851428189
Provider Name (Legal Business Name): JENKINS HOUSING INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/27/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3401 CHAPEL PINES DRIVE SOUTH
PINE BLUFF AR
71603
US

IV. Provider business mailing address

2410 RIKE DR
PINE BLUFF AR
71603-3935
US

V. Phone/Fax

Practice location:
  • Phone: 870-879-0311
  • Fax: 870-879-0194
Mailing address:
  • Phone: 870-534-2035
  • Fax: 870-534-2058

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code315P00000X
TaxonomyIntellectual Disabilities Intermediate Care Facility
License Number
License Number State

VIII. Authorized Official

Name: MS. ZELDA HOAGLAN
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 870-534-2035