KMJ Enterprises Bentonville Manor LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

712 Issued in AR

Legal business name

KMJ ENTERPRISES BENTONVILLE MANOR LLC

Doing business as

Bentonville Manor Nursing Home

Practice address

224 S Main St
Bentonville, AR 72712-5963

Phone

(479) 273-3373

Fax

(479) 273-0623

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

Ms. Patricia Miller

Title

President/Ceo

Phone

(479) 636-5716

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Bentonville Manor Nursing 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": "1619964160",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "224 S MAIN ST",
            "city": "BENTONVILLE",
            "state": "AR",
            "postal_code": "727125963",
            "telephone_number": "479-273-3373",
            "fax_number": "479-273-0623"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "224 S MAIN ST",
            "city": "BENTONVILLE",
            "state": "AR",
            "postal_code": "727125963",
            "telephone_number": "479-273-3373",
            "fax_number": "479-273-0623"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KMJ ENTERPRISES BENTONVILLE MANOR 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",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "AR",
            "license": "712",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "119720311",
            "state": "AR"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Bentonville Manor Nursing Home",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Sydney Kinser
• Sandra Kinsey, PD
• Timothy W Kirby
• Stephanie Klonowski
• Jennifer Kristin Kloster
• Elizabeth Knapp, MHPP
• Justin J Knapp, MHPP
• Jadarius Knight
• Jenny Knight, PHARM D
• Taylor Matthew Knight

• Skilled Nursing Facility in Bentonville, AR
• Providers in Bentonville, 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.