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NPI Code Detail

MEDICARE: KMJ ENTERPRISES HOMESTEAD LLC

MEDICARE: KMJ ENTERPRISES HOMESTEAD LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1314000000XSkilled Nursing Facility715AR

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1669469854
Entity Type Code : Organization
Provider Name (Legal Business Name) : KMJ ENTERPRISES HOMESTEAD LLC
Provider Business Mailing Address
First Line : 826 NORTH ST
Second Line :
City : STAMPS
State : AR
Zip : 71860-4522
Country : US
Telephone Number : 870-533-4444
Fax Number : 870-533-8841
Provider Business Practice Location Address
First Line : 826 NORTH ST
Second Line :
City : STAMPS
State : AR
Zip : 71860-4522
Country : US
Telephone Number : 870-533-4444
Fax Number : 870-533-8841
Authorized Official
Title or Position : PRESIDENT/CEO
Name : PATRICIA MILLER
Credential :
Telephone Number : 479-636-5716
Provider Enumeration Date : 10/03/2005
Last Update Date : 06/10/2008

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Directions to “KMJ ENTERPRISES HOMESTEAD LLC ” Practice Location

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