Provider Demographics
NPI:1710974274
Name:KMJ ENTERPRISES FIANNA HILLS LLC
Entity Type:Organization
Organization Name:KMJ ENTERPRISES FIANNA HILLS LLC
Other - Org Name:FIANNA HILLS NURSING AND REHABILITATION CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:C
Authorized Official - Last Name:HATHORN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:479-636-5716
Mailing Address - Street 1:8411 S 28TH ST
Mailing Address - Street 2:
Mailing Address - City:FORT SMITH
Mailing Address - State:AR
Mailing Address - Zip Code:72908-8646
Mailing Address - Country:US
Mailing Address - Phone:479-648-9600
Mailing Address - Fax:479-648-9673
Practice Address - Street 1:8411 S 28TH ST
Practice Address - Street 2:
Practice Address - City:FORT SMITH
Practice Address - State:AR
Practice Address - Zip Code:72908-8646
Practice Address - Country:US
Practice Address - Phone:479-648-9600
Practice Address - Fax:479-648-9673
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:KMJ MANAGEMENT
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-09-30
Last Update Date:2024-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR724314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR119732311Medicaid
AR119732311Medicaid