NPIMap

Organization Active NPI

State of Arkansas

  • Intellectual and/or Developmental Disabilities Residential Treatment Facility
  • Conway, AR
National Provider Identifier
1093840282
Registry record updated Aug 24, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Intellectual and/or Developmental Disabilities Residential Treatment FacilityTaxonomy code 320600000X
License
139 Issued in AR
Legal business name
STATE OF ARKANSAS
Practice address
150 Siebenmorgen Rd
Conway, AR 72032
Phone
(501) 329-6851
Fax
(501) 336-0508
NPI assigned
Feb 21, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 24, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Sally Sellers
Title
Business Operations Manager
Phone
(501) 329-6851

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Intellectual and/or Developmental Disabilities Residential Treatment Facility 320600000X 139 AR Primary

Addresses

Primary practice location

150 Siebenmorgen Rd
Conway, AR 72032

Mailing address

150 Siebenmorgen Rd
Conway, AR 72032
Phone (501) 329-6851

Other identifiers 1

IdentifierTypeStateIssuer
109217213MedicaidAR

Other names 1

  • Conway Human Development Center Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

Intermediate care facility for individuals with intellectual disabilities certification: CCN 04G004

Name & address match This certification has no NPI in the Medicare enrollment files. CMS publishes enrollment files for six facility types only, so it was connected to this NPI by matching the name and address CMS publishes for it.

Legal name
CONWAY HUMAN DEVELOPMENT CENTER
Certification status
Active
Provider type (POS)
Intermediate care facility for individuals with intellectual disabilities
Participating since
Jun 4, 1982
Last certification
Oct 25, 2024
Beds
518
Ownership / control type
State
Facility address
150 East Siebenmorgen Rd
Conway, AR 72032

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
04D0642170Conway Human Development Center150 East Siebenmorgen Road, Conway, AR 72032ComplianceNov 21, 2027

National Provider Directory

National Provider Directory
Tax ID family
State of Arkansas14 organizations share this tax ID, including this one

Other organizations with this tax ID 13

Organizations that report the same tax identification number in the National Provider Directory.

View all 13

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1172016000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1692835200000",
    "number": "1093840282",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "150 SIEBENMORGEN RD",
            "city": "CONWAY",
            "state": "AR",
            "postal_code": "72032",
            "telephone_number": "501-329-6851",
            "fax_number": "501-336-0508"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "150 SIEBENMORGEN RD",
            "city": "CONWAY",
            "state": "AR",
            "postal_code": "72032",
            "telephone_number": "501-329-6851",
            "fax_number": "501-336-0508"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "STATE OF ARKANSAS",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-21",
        "last_updated": "2023-08-24",
        "status": "A",
        "authorized_official_last_name": "SELLERS",
        "authorized_official_first_name": "SALLY",
        "authorized_official_title_or_position": "BUSINESS OPERATIONS MANAGER",
        "authorized_official_telephone_number": "501-329-6851"
    },
    "taxonomies": [
        {
            "code": "320600000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": "AR",
            "license": "139",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "109217213",
            "state": "AR"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Conway Human Development Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Conway Human Development Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Conway, AR

Sources for this page

Verify at the official NPI Registry.