Active NPI
Jacqueline Kilgore LLC
- Skilled Nursing Facility
- Malvern, AR
National Provider Identifier
1730305798
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Skilled Nursing Facility
- License
- 656
- Legal business name
- JACQUELINE KILGORE LLC
- Doing business as
- LONGMEADOW NURSING CENTER
- Practice address
- 912 Section Line St
Malvern, AR 72104 - Phone
- (501) 332-6934
- Fax
- (501) 332-6838
- NPI assigned
- Apr 18, 2007
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Avon Mitchell
- Title
- Office Manager
- Phone
- (501) 332-6934
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Skilled Nursing Facility | 314000000X | 656 | AR | Primary |
Addresses
Primary practice location
912 Section Line St
Malvern, AR 72104
Mailing address
P.O. Box 566
Malvern, AR 72104
Phone (501) 332-6934
Other names 1
- LONGMEADOW NURSING CENTER
National Provider Directory
National Provider DirectoryNPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1176854400000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1264636800000",
"number": "1730305798",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "P.O. BOX 566",
"city": "MALVERN",
"state": "AR",
"postal_code": "72104",
"telephone_number": "501-332-6934",
"fax_number": "501-332-6838"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "912 SECTION LINE ST",
"city": "MALVERN",
"state": "AR",
"postal_code": "72104",
"telephone_number": "501-332-6934",
"fax_number": "501-332-6838"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "JACQUELINE KILGORE LLC",
"organizational_subpart": "NO",
"enumeration_date": "2007-04-18",
"last_updated": "2010-01-28",
"status": "A",
"authorized_official_last_name": "MITCHELL",
"authorized_official_first_name": "AVON",
"authorized_official_title_or_position": "OFFICE MANAGER",
"authorized_official_telephone_number": "501-332-6934"
},
"taxonomies": [
{
"code": "314000000X",
"taxonomy_group": "",
"desc": "Skilled Nursing Facility",
"state": "AR",
"license": "656",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"organization_name": "LONGMEADOW NURSING CENTER",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Malvern, AR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 28, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.