Organization
CB KING JM
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. ORBY GENE GREGORY (EXECUTIVE DIRECTOR)
(870) 222-4544
Entity
Organization
Contact information
Practice address
1109 NORTH SCHOOL, DERMOTT, AR 71638-0000
(870) 538-9659
Mailing address
1109 NORTH SCHOOL, DERMOTT, AR 71638
(870) 538-9659
(870) 538-9659
Taxonomy
Speciality
Code
Description
License number
State
251C00000X
Developmentally Disabled Services Day Training Agency
Primary
27992
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
19554724
—
AR
Enumeration date
01/15/2014
Last updated
01/15/2014
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