Healthcare Provider Details

I. General information

NPI: 1376870675
Provider Name (Legal Business Name): KIMBERLY COMMUNITIES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/06/2009
Last Update Date: 11/06/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 DEER VIEW WAY
JEFFERSON CITY TN
37760-4063
US

IV. Provider business mailing address

PO BOX 767
JEFFERSON CITY TN
37760-0767
US

V. Phone/Fax

Practice location:
  • Phone: 865-471-1400
  • Fax: 865-471-1410
Mailing address:
  • Phone: 865-471-6800
  • Fax: 865-471-6777

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number185
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code311500000X
TaxonomyAlzheimer Center (Dementia Center)
License Number185
License Number StateTN

VIII. Authorized Official

Name: KIMBERLY SHELTON
Title or Position: EXECUTIVE DIRECTOR
Credential: RNC
Phone: 865-471-1400