MEDICARE: KMJ ENTERPRISES FIANNA HILLS 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
1	314000000X	Skilled Nursing Facility	724	AR

Other Identifiers

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

General Provider Information

NPI Number	:	1710974274
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KMJ ENTERPRISES FIANNA HILLS LLC

Provider Business Mailing Address
First Line	:	8411 S 28TH ST
Second Line	:
City	:	FORT SMITH
State	:	AR
Zip	:	72908-8646
Country	:	US
Telephone Number	:	479-648-9600
Fax Number	:	479-648-9673

Provider Business Practice Location Address
First Line	:	8411 S 28TH ST
Second Line	:
City	:	FORT SMITH
State	:	AR
Zip	:	72908-8646
Country	:	US
Telephone Number	:	479-648-9600
Fax Number	:	479-648-9673

Authorized Official
Title or Position	:	PRESIDENT/CEO
Name	:	MICHAEL C HATHORN
Credential	:
Telephone Number	:	479-636-5716

Provider Enumeration Date	:	09/30/2005
Last Update Date	:	04/18/2024

Similar Medicare Providers

1962388488 — MIKELLE PORTER M.S, CF-SLP
Practice Location Address:

8411 S 28TH ST
FORT SMITH, AR
72908-8646

Practice Phone: 479-648-9600
Practice Fax:

1932936424 — WELLMIND THERAPY CENTER
Practice Location Address:

3418 N TARRANT PKWY STE 320
FORT WORTH, TX
76177-8646

Practice Phone: 682-378-0808
Practice Fax:

1295614246 — JOEL JASSO LMFT-A
Practice Location Address:

3418 N TARRANT PKWY STE 320
FORT WORTH, TX
76177-8646

Practice Phone: 817-653-9027
Practice Fax:

1871596916 — FORT SMITH REGIONAL DIALYSIS CENTER LLC
Practice Location Address:

2201 BROOKEN HILL DR
FORT SMITH, AR
72908-8611

Practice Phone: 479-755-6700
Practice Fax: 479-755-6704

1417942731 — LAWS VILLAGE PHARMACY, INC.
Practice Location Address:

2504 MARKET TRCE
FORT SMITH, AR
72908-8676

Practice Phone: 479-646-5505
Practice Fax: 479-649-7535

1104812767 — MRS. ALLISON D CLEM RPH
Practice Location Address:

2504 MARKET TRCE
FORT SMITH, AR
72908-8676

Practice Phone: 479-646-5505
Practice Fax: 479-649-7535

Directions to “KMJ ENTERPRISES FIANNA HILLS LLC ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2025 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.