Kimberly Black

Primary specialty

Adult Care Home FacilityTaxonomy code 311ZA0620X

License

6906527 Issued in FL

Legal business name

KIMBERLY BLACK

Practice address

3794 Victoria Rd
West Palm BCH, FL 33411-6440

Phone

(561) 629-5067

NPI assigned

Apr 8, 2013

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Kimberly Black

Title

Administrator

Phone

(561) 629-5067

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Kimberly Kares Helping Hands Doing business as

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1365379200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1417392000000",
    "number": "1144663261",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3794 VICTORIA RD",
            "city": "WEST PALM BCH",
            "state": "FL",
            "postal_code": "334116440",
            "telephone_number": "561-629-5067"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3794 VICTORIA RD",
            "city": "WEST PALM BCH",
            "state": "FL",
            "postal_code": "334116440",
            "telephone_number": "561-629-5067"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KIMBERLY BLACK",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-04-08",
        "last_updated": "2014-12-01",
        "status": "A",
        "authorized_official_last_name": "BLACK",
        "authorized_official_first_name": "KIMBERLY",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "561-629-5067"
    },
    "taxonomies": [
        {
            "code": "311ZA0620X",
            "taxonomy_group": "",
            "desc": "Custodial Care Facility, Adult Care Home",
            "state": "FL",
            "license": "6906527",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "006441900",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Kimberly Kares Helping Hands",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Adult Care Home Facility in West Palm BCH, FL
• Providers in West Palm BCH, FL by specialty
• Adult Care Home Facility in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 1, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.