NPIMap

Organization Active NPI

Kimberly's Residential Care HM

  • Adult Care Home Facility
  • Rancho Cordova, CA
National Provider Identifier
1902969884
Registry record updated Jun 24, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adult Care Home FacilityTaxonomy code 311ZA0620X
License
340309353 Issued in CA
Legal business name
KIMBERLY'S RESIDENTIAL CARE HM
Practice address
10514 Mills Tower Drive
Rancho Cordova, CA 95670
Phone
(916) 362-4473
Fax
(916) 362-4473
NPI assigned
Dec 19, 2006
Last updated
Jun 24, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 24, 2008

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

Authorized official

Name
Mike G Tampus
Title
Owner
Phone
(916) 631-7969

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Adult Care Home Facility 311ZA0620X 340309353 CA Primary

Addresses

Primary practice location

10514 Mills Tower Drive
Rancho Cordova, CA 95670

Mailing address

2218 Bucks Creek Court
Gold River, CA 95670
Phone (916) 631-7969

National Provider Directory

National Provider Directory
Tax ID family
Kimberly Beverly's Guest 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.

NPI Registry JSON

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

{
    "created_epoch": "1166486400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1214265600000",
    "number": "1902969884",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2218 BUCKS CREEK COURT",
            "city": "GOLD RIVER",
            "state": "CA",
            "postal_code": "95670",
            "telephone_number": "916-631-7969",
            "fax_number": "916-638-8880"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10514 MILLS TOWER DRIVE",
            "city": "RANCHO CORDOVA",
            "state": "CA",
            "postal_code": "95670",
            "telephone_number": "916-362-4473",
            "fax_number": "916-362-4473"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KIMBERLY'S RESIDENTIAL CARE HM",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-19",
        "last_updated": "2008-06-24",
        "status": "A",
        "authorized_official_last_name": "TAMPUS",
        "authorized_official_first_name": "MIKE",
        "authorized_official_middle_name": "G",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "916-631-7969"
    },
    "taxonomies": [
        {
            "code": "311ZA0620X",
            "taxonomy_group": "",
            "desc": "Custodial Care Facility, Adult Care Home",
            "state": "CA",
            "license": "340309353",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Rancho Cordova, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 24, 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.