Kimwell Healthcare LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

0720 Issued in MA

Legal business name

KIMWELL HEALTHCARE LLC

Practice address

495 New Boston Rd
Fall River, MA 02720-5835

Phone

(508) 679-0106

Fax

(508) 674-1570

NPI assigned

Jun 1, 2006

Organization subpart

No

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

Authorized official

Name

John G. Fredette

Title

Manager

Phone

(508) 679-0106

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• Kimwell Doing business as

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

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

{
    "created_epoch": "1149120000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1414627200000",
    "number": "1376580266",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "495 NEW BOSTON RD",
            "city": "FALL RIVER",
            "state": "MA",
            "postal_code": "027205835",
            "telephone_number": "508-679-0106",
            "fax_number": "508-674-1570"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "495 NEW BOSTON RD",
            "city": "FALL RIVER",
            "state": "MA",
            "postal_code": "027205835",
            "telephone_number": "508-679-0106",
            "fax_number": "508-674-1570"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KIMWELL HEALTHCARE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-01",
        "last_updated": "2014-10-30",
        "status": "A",
        "authorized_official_last_name": "FREDETTE",
        "authorized_official_first_name": "JOHN",
        "authorized_official_middle_name": "G.",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "508-679-0106"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "MA",
            "license": "0720",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "110026658B",
            "state": "MA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0940542",
            "state": "MA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Kimwell",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Abigail Killeen
• Jennifer Townsend Killenberg, M.S.W.
• Kevin Patrick Kilroy, D.D.S.
• Nicholas S Kim, DMD MD
• Benjamin Joel Kimball, B.A.
• Kimwell Nursing SNF Operations BHC
• Kimwell Operating LLC
• Kimwell SNF Opco LLC
• King de Melo Southcoast Foot Care
• Brittany King

• Skilled Nursing Facility in Fall River, MA
• Providers in Fall River, MA by specialty
• Skilled Nursing Facility in Massachusetts

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 30, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.