Provider Demographics
NPI:1902969884
Name:KIMBERLY'S RESIDENTIAL CARE HM
Entity Type:Organization
Organization Name:KIMBERLY'S RESIDENTIAL CARE HM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MIKE
Authorized Official - Middle Name:G
Authorized Official - Last Name:TAMPUS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:916-631-7969
Mailing Address - Street 1:2218 BUCKS CREEK COURT
Mailing Address - Street 2:
Mailing Address - City:GOLD RIVER
Mailing Address - State:CA
Mailing Address - Zip Code:95670
Mailing Address - Country:US
Mailing Address - Phone:916-631-7969
Mailing Address - Fax:916-638-8880
Practice Address - Street 1:10514 MILLS TOWER DRIVE
Practice Address - Street 2:
Practice Address - City:RANCHO CORDOVA
Practice Address - State:CA
Practice Address - Zip Code:95670
Practice Address - Country:US
Practice Address - Phone:916-362-4473
Practice Address - Fax:916-362-4473
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-19
Last Update Date:2008-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA340309353311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home