Organization
KMJ ENTERPRISES MOUNTAIN HOME LLC
Active
Parent organization
KMJ MANAGEMENT
Other names
Pine Lane Healthcare
Organization subpart
Yes
Provider details
NPI number
Legal business name
KMJ MANAGEMENT
Authorized official
PATRICIA MILLER (PRESIDENT CEO)
(479) 636-5716
Entity
Organization
Contact information
Practice address
1100 PINE TREE LN, MOUNTAIN HOME, AR 72653-4502
(870) 425-6316
(870) 424-5197
Mailing address
1100 PINE TREE LN, MOUNTAIN HOME, AR 72653-4502
(870) 425-6316
(870) 424-5197
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
720
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
119728311
—
AR
Enumeration date
10/03/2005
Last updated
06/13/2008
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