Provider Demographics
NPI:1114352424
Name:KIMBERLY PERINO
Entity Type:Organization
Organization Name:KIMBERLY PERINO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LPN
Authorized Official - Prefix:MRS
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:PERINO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:815-379-2700
Mailing Address - Street 1:372 POLO RD
Mailing Address - Street 2:
Mailing Address - City:DEER GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:61243-9725
Mailing Address - Country:US
Mailing Address - Phone:815-379-2700
Mailing Address - Fax:
Practice Address - Street 1:372 POLO RD
Practice Address - Street 2:
Practice Address - City:DEER GROVE
Practice Address - State:IL
Practice Address - Zip Code:61243-9725
Practice Address - Country:US
Practice Address - Phone:815-379-2700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-05
Last Update Date:2013-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL043082854251J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care