Provider Demographics
NPI:1609916519
Name:KIMES CONVALESCENT CENTER, LTD
Entity Type:Organization
Organization Name:KIMES CONVALESCENT CENTER, LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:
Authorized Official - Last Name:BUCKLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:740-593-3391
Mailing Address - Street 1:75 KIMES LN
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:OH
Mailing Address - Zip Code:45701-3801
Mailing Address - Country:US
Mailing Address - Phone:740-593-3391
Mailing Address - Fax:740-594-1632
Practice Address - Street 1:75 KIMES LN
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:OH
Practice Address - Zip Code:45701-3801
Practice Address - Country:US
Practice Address - Phone:740-593-3391
Practice Address - Fax:740-594-1632
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-08
Last Update Date:2010-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1226N314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2224800Medicaid
OH366250Medicare ID - Type Unspecified