Provider Demographics
NPI:1447478060
Name:CB KING MEMORIAL SCHOOL, INC.
Entity type:Organization
Organization Name:CB KING MEMORIAL SCHOOL, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ORBY
Authorized Official - Middle Name:GENE
Authorized Official - Last Name:GREGORY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:870-222-4544
Mailing Address - Street 1:PO BOX 1051
Mailing Address - Street 2:
Mailing Address - City:MCGEHEE
Mailing Address - State:AR
Mailing Address - Zip Code:71654-1051
Mailing Address - Country:US
Mailing Address - Phone:870-222-6211
Mailing Address - Fax:870-222-6213
Practice Address - Street 1:1402 CB KING DR.
Practice Address - Street 2:
Practice Address - City:MCGEHEE
Practice Address - State:AR
Practice Address - Zip Code:71654-1051
Practice Address - Country:US
Practice Address - Phone:870-222-6211
Practice Address - Fax:870-222-6213
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CB KING MEMORIAL SCHOOL, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-04-20
Last Update Date:2008-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR251C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services