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General NPI Number Information
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NPI Number | 1518355932
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Entity Type | Organization
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Legal Business Name | KIMBERLY WHITE
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Dates
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Enumeration Date | 01/07/2015
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Last Update Date | 01/07/2015
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Provider Practice Location Address
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Address Line | 137 PEARL ST
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City | PAINESVILLE
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State | OH
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Zip | 44077-3579
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Country | US
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Telephone | 440-579-5294
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Fax |
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Provider Business Mailing Address
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Address Line | 137 PEARL ST
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City | PAINESVILLE
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State | OH
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Zip | 44077-3579
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Country | US
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Telephone | 440-579-5294
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Fax |
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Authorized Official
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Title or Position | RN
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Name | MRS. KIMBERLY REGINA WHITE
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Credential | RN
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Telephone | 440-579-5294
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 315P00000X
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Taxonomy Name | Intellectual Disabilities Intermediate Care Facility
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License Number | 163W00000X
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License Number State | OH
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