KMJ Enterprises Clarksville LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

702 Issued in AR

Legal business name

KMJ ENTERPRISES CLARKSVILLE LLC

Doing business as

Clarksville Convalescent Home

Practice address

400 Oak CT
Clarksville, AR 72830-3778

Phone

(479) 754-8611

Fax

(479) 754-2369

NPI assigned

Sep 30, 2005

Organization subpart

Yes

Parent organization

KMJ MANAGEMENTAs reported in NPPES

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

Authorized official

Name

Patricia Miller

Title

President/Ceo

Phone

(479) 636-5716

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Clarksville Convalescent Home Doing business as

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

{
    "created_epoch": "1128038400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1213056000000",
    "number": "1124015680",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "400 OAK CT",
            "city": "CLARKSVILLE",
            "state": "AR",
            "postal_code": "728303778",
            "telephone_number": "479-754-8611",
            "fax_number": "479-754-2369"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "400 OAK CT",
            "city": "CLARKSVILLE",
            "state": "AR",
            "postal_code": "728303778",
            "telephone_number": "479-754-8611",
            "fax_number": "479-754-2369"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KMJ ENTERPRISES CLARKSVILLE LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "KMJ MANAGEMENT",
        "enumeration_date": "2005-09-30",
        "last_updated": "2008-06-10",
        "status": "A",
        "authorized_official_last_name": "MILLER",
        "authorized_official_first_name": "PATRICIA",
        "authorized_official_title_or_position": "PRESIDENT/CEO",
        "authorized_official_telephone_number": "479-636-5716"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "AR",
            "license": "702",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "119715311",
            "state": "AR"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Clarksville Convalescent Home",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Rebecca Keylon
• Derek Killane
• Amanda Kimbrough
• Josh Kimes, RECOVERY ASSISTANT
• April Gale Kirk, LCSW
• Jessica Knight, CMP
• Lynsey Koch, RN
• Nelda Marlene Kraus
• Kirklyn Kremers, PT, DPT
• Victoria Anne Kremers

• Skilled Nursing Facility in Clarksville, AR
• Providers in Clarksville, AR by specialty
• Skilled Nursing Facility in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 10, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.