Provider Demographics
NPI:1376870675
Name:KIMBERLY COMMUNITIES
Entity Type:Organization
Organization Name:KIMBERLY COMMUNITIES
Other - Org Name:CHANDLER HOUSE ASSISTED LIVING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:
Authorized Official - Last Name:SHELTON
Authorized Official - Suffix:
Authorized Official - Credentials:RNC
Authorized Official - Phone:865-471-1400
Mailing Address - Street 1:PO BOX 767
Mailing Address - Street 2:
Mailing Address - City:JEFFERSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37760-0767
Mailing Address - Country:US
Mailing Address - Phone:865-471-6800
Mailing Address - Fax:865-471-6777
Practice Address - Street 1:550 DEER VIEW WAY
Practice Address - Street 2:
Practice Address - City:JEFFERSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37760-4063
Practice Address - Country:US
Practice Address - Phone:865-471-1400
Practice Address - Fax:865-471-1410
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-06
Last Update Date:2009-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN185310400000X, 311500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
No311500000XNursing & Custodial Care FacilitiesAlzheimer Center (Dementia Center)