NPIMap

Organization Active NPI

Kimberly Home

  • Intellectual and/or Developmental Disabilities Residential Treatment Facility
  • Raleigh, NC
National Provider Identifier
1427214956
Registry record updated Aug 4, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Intellectual and/or Developmental Disabilities Residential Treatment FacilityTaxonomy code 320600000X
License
MHL092633 Issued in NC
Legal business name
KIMBERLY HOME
Practice address
6701 Litchford Rd
Raleigh, NC 27615-7112
Phone
(919) 798-8638
Fax
(919) 872-5412
NPI assigned
Aug 4, 2008
Last updated
Aug 4, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 4, 2008

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

Authorized official

Name
Charlmayne Seaberry AlstonNPI 1619186970
Title
Chief Executive Officer
Phone
(919) 798-8638

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Intellectual and/or Developmental Disabilities Residential Treatment Facility 320600000X MHL092633 NC Primary

Addresses

Primary practice location

6701 Litchford Rd
Raleigh, NC 27615-7112

Mailing address

1733 Hodge Rd
Knightdale, NC 27545-9588
Phone (919) 872-5412

Other identifiers 1

IdentifierTypeStateIssuer
7805399MedicaidNC

National Provider Directory

National Provider Directory
Tax ID family
Kimberly Home3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1217808000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1217808000000",
    "number": "1427214956",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1733 HODGE RD",
            "city": "KNIGHTDALE",
            "state": "NC",
            "postal_code": "275459588",
            "telephone_number": "919-872-5412",
            "fax_number": "919-872-5412"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6701 LITCHFORD RD",
            "city": "RALEIGH",
            "state": "NC",
            "postal_code": "276157112",
            "telephone_number": "919-798-8638",
            "fax_number": "919-872-5412"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KIMBERLY HOME",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-08-04",
        "last_updated": "2008-08-04",
        "status": "A",
        "authorized_official_last_name": "ALSTON",
        "authorized_official_first_name": "CHARLMAYNE",
        "authorized_official_middle_name": "SEABERRY",
        "authorized_official_title_or_position": "CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "919-798-8638"
    },
    "taxonomies": [
        {
            "code": "320600000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": "NC",
            "license": "MHL092633",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7805399",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Raleigh, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 4, 2008; 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.