Provider Demographics
NPI:1962413989
Name:JENKINS MEMORIAL CENTER & JENKINS INDUSTRIES, INC.
Entity type:Organization
Organization Name:JENKINS MEMORIAL CENTER & JENKINS INDUSTRIES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:ZELDA
Authorized Official - Middle Name:
Authorized Official - Last Name:HOAGLAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:870-534-2035
Mailing Address - Street 1:2410 RIKE DR
Mailing Address - Street 2:
Mailing Address - City:PINE BLUFF
Mailing Address - State:AR
Mailing Address - Zip Code:71603-3935
Mailing Address - Country:US
Mailing Address - Phone:870-534-2035
Mailing Address - Fax:870-534-2058
Practice Address - Street 1:2410 RIKE DR
Practice Address - Street 2:
Practice Address - City:PINE BLUFF
Practice Address - State:AR
Practice Address - Zip Code:71603-3935
Practice Address - Country:US
Practice Address - Phone:870-534-2035
Practice Address - Fax:870-534-2058
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-11
Last Update Date:2007-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARDDS222Q00000X, 251C00000X, 347E00000X
225100000X, 225X00000X, 235Z00000X
CADDS231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
No222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental TherapistGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
No231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
No347E00000XTransportation ServicesTransportation BrokerGroup - Multi-Specialty