Provider Demographics
NPI:1548359557
Name:KIMBERLY HEALTHCARE GROUP LLC
Entity type:Organization
Organization Name:KIMBERLY HEALTHCARE GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:L
Authorized Official - Last Name:BOUCHARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:860-667-9933
Mailing Address - Street 1:17 WATERHOUSE LN
Mailing Address - Street 2:
Mailing Address - City:CHESTER
Mailing Address - State:CT
Mailing Address - Zip Code:06412-1267
Mailing Address - Country:US
Mailing Address - Phone:860-667-9933
Mailing Address - Fax:860-667-4069
Practice Address - Street 1:133 LOUIS ST
Practice Address - Street 2:
Practice Address - City:NEWINGTON
Practice Address - State:CT
Practice Address - Zip Code:06111-4517
Practice Address - Country:US
Practice Address - Phone:860-667-9933
Practice Address - Fax:860-667-4069
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-11
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
N/A332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT5643510001Medicare ID - Type UnspecifiedREGION A