Healthcare Provider Details

I. General information

NPI: 1609916519
Provider Name (Legal Business Name): KIMES CONVALESCENT CENTER, LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/08/2007
Last Update Date: 02/25/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

75 KIMES LN
ATHENS OH
45701-3801
US

IV. Provider business mailing address

75 KIMES LN
ATHENS OH
45701-3801
US

V. Phone/Fax

Practice location:
  • Phone: 740-593-3391
  • Fax: 740-594-1632
Mailing address:
  • Phone: 740-593-3391
  • Fax: 740-594-1632

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number1226N
License Number StateOH

VIII. Authorized Official

Name: LAURA BUCKLEY
Title or Position: ADMINISTRATOR
Credential:
Phone: 740-593-3391