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General NPI Number Information
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NPI Number | 1932817517
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Entity Type | Organization
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Legal Business Name | KIMS ASSISTED LIVING LLC
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Dates
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Enumeration Date | 11/11/2022
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Last Update Date | 06/18/2025
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Provider Practice Location Address
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Address Line | 1241 GOINS RD
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City | PEMBROKE
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State | NC
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Zip | 28372-8347
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Country | US
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Telephone | 910-827-7973
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Fax |
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Provider Business Mailing Address
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Address Line | 1241 GOINS RD
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City | PEMBROKE
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State | NC
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Zip | 28372-8347
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Country | US
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Telephone | 910-827-7973
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | KIMBERLY DALE JACOBS
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Credential | LPN
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Telephone | 910-536-2253
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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 |
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License Number State |
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