State of Arkansas
Organization Active NPI Intellectual Disabilities Intermediate Care Facility · Booneville, AR
NPI 1801928627 · NPPES record last updated Jun 25, 2008
Key facts
- NPI
- 1801928627
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Intellectual Disabilities Intermediate Care Facility 315P00000X
- Legal business name
- STATE OF ARKANSAS
- Practice address
- 87 Reed Rd
Highway 116 South
Booneville, AR 72927 - Phone
- (479) 675-2121
- Fax
- (479) 675-5820
- NPI assigned
- Mar 9, 2007
- Organization subpart
- No
Authorized official
- Name
- Judy L. Storey
- Title
- Director of Operations
- Phone
- (479) 675-1411
Corporate family (same tax ID) 13
Practitioners 1
-
Elaine J. Wilson, M.D.
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 04D0919709 | Booneville Human Development Center | Provider-performed microscopy | Apr 14, 2028 |
National Provider Directory
- Tax ID family
- State of Arkansas
Locations
87 Reed Rd
Booneville, AR 72927
Phone (479) 675-2121
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Intellectual Disabilities Intermediate Care Facility | 315P00000X | AR | Yes |
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
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 109051213 | Medicaid | AR |
Other names
- Booneville Human Development Center
Other providers in Booneville, AR
- Rachel Beth Sing
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- South Logan Family Practice
- Cole Havard Stanton
- State of Arkansas
- William Andrew Stevenson IV
- Virginia L Strickland
- Superintendent of Booneville High School
- The Guidance Center - Booneville Clinic
- The Guidance Center - Horizon Renewal Center
All providers in Booneville, AR · Intellectual Disabilities Intermediate Care Facility in Arkansas
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 25, 2008. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.