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General NPI Number Information
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NPI Number | 1609232438
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Entity Type | Organization
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Legal Business Name | KIMBERLY'S ELDER KARE KOTTAGE
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Dates
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Enumeration Date | 01/08/2016
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Last Update Date | 01/08/2016
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Provider Practice Location Address
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Address Line | 2770 MOORPARK AVE
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City | SAN JOSE
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State | CA
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Zip | 95128-3153
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Country | US
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Telephone | 408-483-2433
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Fax | 408-554-6656
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Provider Business Mailing Address
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Address Line | 2770 MOORPARK AVE
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City | SAN JOSE
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State | CA
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Zip | 95128-3153
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Country | US
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Telephone | 408-483-2433
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Fax | 408-554-6656
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Authorized Official
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Title or Position | OWNER/ADMINISTRATOR
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Name | MR. PATRICK HALL
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Credential |
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Telephone | 408-483-2433
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number | 435294206
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License Number State | CA
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