Provider Demographics
NPI:1184226235
Name:KIMBERCARE HOMES
Entity Type:Organization
Organization Name:KIMBERCARE HOMES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:MICHELE
Authorized Official - Last Name:BUCHANAN
Authorized Official - Suffix:
Authorized Official - Credentials:RESIDENTIAL PROVIDER
Authorized Official - Phone:330-990-2439
Mailing Address - Street 1:1510 SUMMER WOOD LN
Mailing Address - Street 2:
Mailing Address - City:UNIONTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44685-7797
Mailing Address - Country:US
Mailing Address - Phone:330-990-2439
Mailing Address - Fax:234-294-0017
Practice Address - Street 1:1510 SUMMER WOOD LN
Practice Address - Street 2:
Practice Address - City:UNIONTOWN
Practice Address - State:OH
Practice Address - Zip Code:44685-7797
Practice Address - Country:US
Practice Address - Phone:330-990-2439
Practice Address - Fax:234-294-0017
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-13
Last Update Date:2020-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes376J00000XNursing Service Related ProvidersHomemakerGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2806628Medicaid