KMJ Enterprises Mountain Home LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

720 Issued in AR

Legal business name

KMJ ENTERPRISES MOUNTAIN HOME LLC

Doing business as

Pine Lane Healthcare

Practice address

1100 Pine Tree LN
Mountain Home, AR 72653-4502

Phone

(870) 425-6316

Fax

(870) 424-5197

NPI assigned

Oct 3, 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

Patricia Miller

Title

President Ceo

Phone

(479) 636-5716

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Pine Lane Healthcare Doing business as

Locations

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

{
    "created_epoch": "1128297600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1213315200000",
    "number": "1871580076",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1100 PINE TREE LN",
            "city": "MOUNTAIN HOME",
            "state": "AR",
            "postal_code": "726534502",
            "telephone_number": "870-425-6316",
            "fax_number": "870-424-5197"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1100 PINE TREE LN",
            "city": "MOUNTAIN HOME",
            "state": "AR",
            "postal_code": "726534502",
            "telephone_number": "870-425-6316",
            "fax_number": "870-424-5197"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KMJ ENTERPRISES MOUNTAIN HOME LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "KMJ MANAGEMENT",
        "enumeration_date": "2005-10-03",
        "last_updated": "2008-06-13",
        "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"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "AR",
            "license": "720",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "119728311",
            "state": "AR"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Pine Lane Healthcare",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Crystal D King
• Elka Summers King, R.PH.
• Mackenzie Jo King, PHARM. D
• Mark Steven King, M.D.
• William R King, MD
• Amber Knight
• Angie Marie Knight, APRN-CNP, FNP-C/BC
• Thomas E Knox, M.D.
• Akihiro Kobayashi, M.B.
• Samantha Koch

• Skilled Nursing Facility in Mountain Home, AR
• Providers in Mountain Home, 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 13, 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.