Provider Demographics
NPI:1376607929
Name:KIMBERLY & BEVERLY'S GUEST HOME
Entity Type:Organization
Organization Name:KIMBERLY & BEVERLY'S GUEST HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
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 CT
Mailing Address - Street 2:
Mailing Address - City:GOLD RIVER
Mailing Address - State:CA
Mailing Address - Zip Code:95670-8121
Mailing Address - Country:US
Mailing Address - Phone:916-631-7969
Mailing Address - Fax:916-638-8880
Practice Address - Street 1:10100 COUNTRYSIDE WAY
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95827-5517
Practice Address - Country:US
Practice Address - Phone:916-366-3111
Practice Address - Fax:916-638-8880
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-20
Last Update Date:2008-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA340312905311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home