CB KING JM (NPI# 1609298306) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1609298306 |
| Entity Type | Organization |
| Organization Name | CB KING JM |
| Practice Address |
1109 North School Dermott AR 71638-0000 |
| Mailing Address |
1109 North School Dermott AR 71638 |
| Practice Telephone | 8705389659 |
| Mailing Telephone | 8705389659 |
| Mailing Fax Number | 8705389659 |
| Enumeration Date | 2014-01-15 |
| Last Update Date | 2014-01-15 |
| Authorized Official Name | MR. ORBY GENE GREGORY (EXECUTIVE DIRECTOR) |
| Authorized Official Telephone | 8702224544 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 251C00000X | Day Training, Developmentally Disabled Services | 27992 | AR | Agencies |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| AR | 19554724 | 05 |
| Street Address |
1109 NORTH SCHOOL |
| City | DERMOTT |
| State | AR |
| Zip Code | 71638-0000 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1104251180 | Rebekah Ayecock | Nurse Practitioner | 300 South School St, Dermott, AR 71638 | 2013-09-09 |
| 1508198201 | Roger Alan Mason | Surgery | 300 South School St., Dermott, AR 71638 | 2010-02-04 |
| 1730219353 | Dermott Day Service Center, Inc. | Day Training, Developmentally Disabled Services | 817 North School Street, Dermott, AR 71638 | 2007-03-06 |
| 1134286750 | Dermott City Nursing Home | Skilled Nursing Facility | 702 West Gaines St., Dermott, AR 71638 | 2007-01-02 |
| 1861555005 | Dermott High School | Local Education Agency (LEA) | 525 East Speedway, Dermott, AR 71638 | 2006-12-19 |
| 1811095656 | Phillip W Pennington | Dentist | 300 S School, Dermott, AR 71638 | 2006-09-20 |
| 1669401501 | Mainline Health Systems, Inc | Clinic/Center | 134 South Strickland St, Dermott, AR 71638 | 2006-07-02 |
| 1982643409 | Jeffery Fenton Dunn Sr. | Pharmacist | 111 E Peddicord Street, Dermott, AR 71638 | 2006-06-06 |
| 1780119610 | Medical Transport Management, Inc | Ambulance | 109 W Peddicord St, Dermott, AR 71638-2115 | 2017-04-28 |
| 1902191596 | Medical Transport Management, LLC | Ambulance | 111 W Peddicord St, Dermott, AR 71638-2115 | 2011-06-13 |
| Find all providers in zip 71638 | ||||
| Taxonomy Code | 251C00000X |
| Grouping | Agencies |
| Classification | Day Training, Developmentally Disabled Services |
| These agencies are authorized to provide day habilitation services to developmentally disabled individuals who live in their homes. The function of day habilitation is to assist an individual to acquire and maintain those life skills that enable the individual to cope more effectively with the demands of independent living. Also to raise the level of the individual's physical, mental, social, and vocational functioning. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1730219353 | Dermott Day Service Center, Inc. | Day Training, Developmentally Disabled Services | 817 North School Street, Dermott, AR 71638 | 2007-03-06 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1225667082 | Hannah Nicole Montgomery | Day Training, Developmentally Disabled Services | 1525 Merrill Dr, Little Rock, AR 72211-1821 | 2020-04-03 |
| 1801447990 | Abc Children's Academy - Clarksville Site 3 | Day Training, Developmentally Disabled Services | 105 Cherokee Ln, Clarksville, AR 72830-8014 | 2019-09-20 |
| 1679127443 | Abc Children's Academy | Day Training, Developmentally Disabled Services | 308 E 11th St, Russellville, AR 72801-6156 | 2019-07-30 |
| 1780238550 | Abc Children's Academy | Day Training, Developmentally Disabled Services | 110 Library Rd, Dover, AR 72837 | 2019-07-30 |
| 1134685290 | Outcomes Incorporated | Day Training, Developmentally Disabled Services | 4501 S Thompson St, Springdale, AR 72764-7464 | 2019-02-13 |
| 1154772143 | Abc Children's Academy & Developmental Center-clarksville | Day Training, Developmentally Disabled Services | 108 Cherokee Ln, Clarksville, AR 72830-8014 | 2016-06-30 |
| 1851765143 | Kidspot Plus | Day Training, Developmentally Disabled Services | 1823 Grant Ave Ste F, Jonesboro, AR 72401-6148 | 2015-11-24 |
| 1609270057 | Abc Children's Academy & Developmental Center Dover | Day Training, Developmentally Disabled Services | 105 Library Rd, Dover, AR 72837-9005 | 2014-10-14 |
| 1790197473 | Kina Burruss | Day Training, Developmentally Disabled Services | 1501 Dogwood Trl, Malvern, AR 72104-4513 | 2014-05-29 |
| 1023450905 | Childrens Home for Life Foundation | Day Training, Developmentally Disabled Services | 644 County Road 912, Brookland, AR 72417-8658 | 2013-07-22 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.