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General NPI Number Information
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NPI Number | 1902969884
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Entity Type | Organization
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Legal Business Name | KIMBERLY'S RESIDENTIAL CARE HM
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Dates
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Enumeration Date | 12/19/2006
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Last Update Date | 06/24/2008
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Provider Practice Location Address
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Address Line | 10514 MILLS TOWER DRIVE
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City | RANCHO CORDOVA
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State | CA
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Zip | 95670
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Country | US
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Telephone | 916-362-4473
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Fax | 916-362-4473
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Provider Business Mailing Address
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Address Line | 2218 BUCKS CREEK COURT
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City | GOLD RIVER
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State | CA
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Zip | 95670
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Country | US
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Telephone | 916-631-7969
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Fax | 916-638-8880
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Authorized Official
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Title or Position | OWNER
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Name | MIKE G TAMPUS
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Credential |
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Telephone | 916-631-7969
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 311ZA0620X
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Taxonomy Name | Adult Care Home Facility
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License Number | 340309353
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License Number State | CA
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