Provider Demographics
NPI:1881696474
Name:KIMBERLY CARE CENTER INC.
Entity type:Organization
Organization Name:KIMBERLY CARE CENTER INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:WALTER
Authorized Official - Middle Name:M
Authorized Official - Last Name:MATJASICH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-466-0966
Mailing Address - Street 1:3094 S STATE ST
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84115-3834
Mailing Address - Country:US
Mailing Address - Phone:801-466-0966
Mailing Address - Fax:801-466-1955
Practice Address - Street 1:820 W COOK ST
Practice Address - Street 2:
Practice Address - City:SANTA MARIA
Practice Address - State:CA
Practice Address - Zip Code:93458-5414
Practice Address - Country:US
Practice Address - Phone:805-925-8877
Practice Address - Fax:805-349-8371
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZT05563GMedicaid
CAZZT05563GMedicaid