Healthcare Provider Details

I. General information

NPI: 1306761523
Provider Name (Legal Business Name): KIMS KORNER KARES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/13/2026
Last Update Date: 08/13/2026
Certification Date: 08/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1506 W BROADWAY AVE
MINNEAPOLIS MN
55411-2408
US

IV. Provider business mailing address

1145 HUDSON RD APT 228
SAINT PAUL MN
55106-4326
US

V. Phone/Fax

Practice location:
  • Phone: 763-353-5027
  • Fax:
Mailing address:
  • Phone: 763-353-5027
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State

VIII. Authorized Official

Name: KIM RICHARDSON
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 763-353-5027