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General NPI Number Information
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NPI Number | 1568580512
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Entity Type | Organization
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Legal Business Name | KIMMY'S COTTAGE, INC.
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Dates
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Enumeration Date | 03/27/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 601 MANOR VIEW CIR
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City | BRENTWOOD
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State | TN
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Zip | 37027-4366
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Country | US
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Telephone | 615-750-3245
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Fax |
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Provider Business Mailing Address
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Address Line | 1408 DEVENS DR
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City | BRENTWOOD
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State | TN
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Zip | 37027-7214
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Country | US
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Telephone | 615-373-2068
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. STEPHEN BUTLER
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Credential |
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Telephone | 615-218-5158
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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 |
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License Number State | TN
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