Provider Demographics
NPI:1649074725
Name:HUTCHINSON, KIMBERLY ANGELES
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:ANGELES
Last Name:HUTCHINSON
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19706 MARINDA ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68130-3032
Mailing Address - Country:US
Mailing Address - Phone:708-704-6616
Mailing Address - Fax:
Practice Address - Street 1:4642 S 132ND ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68137-1764
Practice Address - Country:US
Practice Address - Phone:402-515-6668
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-01
Last Update Date:2025-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities