Provider Demographics
NPI:1619911450
Name:EASY K FOUNDATION, INC.
Entity Type:Organization
Organization Name:EASY K FOUNDATION, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:KARL
Authorized Official - Middle Name:J
Authorized Official - Last Name:RUSTMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:239-649-1797
Mailing Address - Street 1:HC 80 BOX 1130
Mailing Address - Street 2:
Mailing Address - City:SAGE
Mailing Address - State:AR
Mailing Address - Zip Code:72573-9535
Mailing Address - Country:US
Mailing Address - Phone:870-368-7444
Mailing Address - Fax:
Practice Address - Street 1:HC 80 BOX 1130
Practice Address - Street 2:
Practice Address - City:SAGE
Practice Address - State:AR
Practice Address - Zip Code:72573-9535
Practice Address - Country:US
Practice Address - Phone:870-368-7444
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR320600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities