Healthcare Provider Details

I. General information

NPI: 1396254066
Provider Name (Legal Business Name): KIMI RECOVERY CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/26/2017
Last Update Date: 06/16/2025
Certification Date: 06/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

219 GOODING ST N
TWIN FALLS ID
83301
US

IV. Provider business mailing address

219 GOODING ST N
TWIN FALLS ID
83301-6178
US

V. Phone/Fax

Practice location:
  • Phone: 208-293-8846
  • Fax:
Mailing address:
  • Phone: 208-293-8846
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLPC-6156
License Number StateID
# 3
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: KELLY DAWN SMOTHERS
Title or Position: OWNER
Credential: LPC
Phone: 208-293-8846