NPIMap

Organization Active NPI

State of Arkansas

Doing business as Booneville Human Development Center

  • Intellectual Disabilities Intermediate Care Facility
  • Booneville, AR
National Provider Identifier
1801928627
Registry record updated Jun 25, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Intellectual Disabilities Intermediate Care FacilityTaxonomy code 315P00000X
Legal business name
STATE OF ARKANSAS
Doing business as
Booneville Human Development Center
Practice address
87 Reed Rd
Highway 116 South
Booneville, AR 72927
Phone
(479) 675-2121
Fax
(479) 675-5820
NPI assigned
Mar 9, 2007
Last updated
Jun 25, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 25, 2008

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

Authorized official

Name
Judy L. Storey
Title
Director of Operations
Phone
(479) 675-1411

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Intellectual Disabilities Intermediate Care Facility 315P00000X AR Primary

Addresses

Primary practice location

87 Reed Rd
Highway 116 South
Booneville, AR 72927

Mailing address

87 Reed Rd
Highway 116 South
Booneville, AR 72927
Phone (479) 675-2121

Other identifiers 1

IdentifierTypeStateIssuer
109051213MedicaidAR

Other names 1

  • Booneville Human Development Center Doing business as

Medicare participation

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

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1801928627. Details of each certification follow.

  • CCN 04G003 Intermediate care facility for individuals with intellectual disabilities · Active · Name & address match · Details

Intermediate care facility for individuals with intellectual disabilities certification: CCN 04G003

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
Booneville Human Development Center
Certification status
Active
Provider type (POS)
Intermediate care facility for individuals with intellectual disabilities
Participating since
Mar 30, 1982
Last certification
Feb 11, 2025
Beds
138
Ownership / control type
State
Facility address
87 Reed Road, Hwy 116 South
Booneville, AR 72927

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
04D0919709Booneville Human Development Center87 Reed Road, Booneville, AR 72927Provider-performed microscopyApr 14, 2028

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

Locations

87 Reed Rd
Booneville, AR 72927
Phone (479) 675-2121

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1173398400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1214352000000",
    "number": "1801928627",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "87 REED RD",
            "address_2": "HIGHWAY 116 SOUTH",
            "city": "BOONEVILLE",
            "state": "AR",
            "postal_code": "72927",
            "telephone_number": "479-675-2121",
            "fax_number": "479-675-5820"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "87 REED RD",
            "address_2": "HIGHWAY 116 SOUTH",
            "city": "BOONEVILLE",
            "state": "AR",
            "postal_code": "72927",
            "telephone_number": "479-675-2121",
            "fax_number": "479-675-5820"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "STATE OF ARKANSAS",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-09",
        "last_updated": "2008-06-25",
        "status": "A",
        "authorized_official_last_name": "STOREY",
        "authorized_official_first_name": "JUDY",
        "authorized_official_middle_name": "L.",
        "authorized_official_title_or_position": "DIRECTOR OF OPERATIONS",
        "authorized_official_telephone_number": "479-675-1411"
    },
    "taxonomies": [
        {
            "code": "315P00000X",
            "taxonomy_group": "",
            "desc": "Intermediate Care Facility, Intellectual Disabilities",
            "state": "AR",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "109051213",
            "state": "AR"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Booneville Human Development Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Booneville, AR

Sources for this page

Verify at the official NPI Registry.