NPIMap

Organization Active NPI

CB King JM

  • Developmentally Disabled Services Day Training Agency
  • Dermott, AR
National Provider Identifier
1609298306
Registry record updated Jan 15, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Developmentally Disabled Services Day Training AgencyTaxonomy code 251C00000X
License
27992 Issued in AR
Legal business name
CB KING JM
Practice address
1109 North School
Dermott, AR 71638-0000
Phone
(870) 538-9659
NPI assigned
Jan 15, 2014
Last updated
Jan 15, 2014By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 15, 2014

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

Authorized official

Name
Mr. Orby Gene Gregory
Title
Executive Director
Phone
(870) 222-4544

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Developmentally Disabled Services Day Training Agency 251C00000X 27992 AR Primary

Addresses

Primary practice location

1109 North School
Dermott, AR 71638-0000

Mailing address

1109 North School
Dermott, AR 71638
Phone (870) 538-9659

Other identifiers 1

IdentifierTypeStateIssuer
19554724MedicaidAR

National Provider Directory

National Provider Directory
Tax ID family
CB King Uam Campus10 organizations share this tax ID, including this one

Other organizations with this tax ID 9

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

NPI Registry JSON

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

{
    "created_epoch": "1389744000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1389744000000",
    "number": "1609298306",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1109 NORTH SCHOOL",
            "city": "DERMOTT",
            "state": "AR",
            "postal_code": "71638",
            "telephone_number": "870-538-9659",
            "fax_number": "870-538-9659"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1109 NORTH SCHOOL",
            "city": "DERMOTT",
            "state": "AR",
            "postal_code": "716380000",
            "telephone_number": "870-538-9659"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CB KING JM",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-01-15",
        "last_updated": "2014-01-15",
        "status": "A",
        "authorized_official_last_name": "GREGORY",
        "authorized_official_first_name": "ORBY",
        "authorized_official_middle_name": "GENE",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "870-222-4544",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "251C00000X",
            "taxonomy_group": "",
            "desc": "Day Training, Developmentally Disabled Services",
            "state": "AR",
            "license": "27992",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "19554724",
            "state": "AR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Dermott, AR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 15, 2014; 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.