National Provider Identifier Database

STATE OF ARKANSAS
Intermediate Care Facility, Mentally Retarded

(1) A public institution for care of the mentally retarded or people with related conditions. (2) An institution giving active treatment to mentally retarded or developmentally disabled persons or persons with related conditions. The primary purpose of the institution is to provide health or rehabilitative services to such individuals.


Contact Information

STATE OF ARKANSAS
87 REED RD
HIGHWAY 116 SOUTH
BOONEVILLE, AR72927
Phone: 479-675-2121
Fax: 479-675-5820
Website:
Specialty Taxonomy Code
* Intermediate Care Facility, Mentally Retarded 315P00000X

* Indicates primary specialty

NPI Profile & details for STATE OF ARKANSAS

NPI Number 1801928627
Legal business name
LBN
STATE OF ARKANSAS
Authorized official JUDY STOREY - (DIRECTOR OF OPERATIONS)
Entity Organization
Organization subpart No
Enumeration date 03/09/2007
Last updated 06/25/2008 - About 18 years ago
Sole proprietor1 Not specified
Identifiers
  • AR Medicaid: 109051213

1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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