Kims Assisted Living LLC

Primary specialty

Adult Care Home FacilityTaxonomy code 311ZA0620X

Legal business name

KIMS ASSISTED LIVING LLC

Practice address

1241 Goins Rd
Pembroke, NC 28372-8347

Phone

(910) 827-7973

NPI assigned

Nov 11, 2022

Organization subpart

No

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

Authorized official

Name

Kimberly Dale Jacobs, LPN

Title

Administrator

Phone

(910) 536-2253

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1668124800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1750204800000",
    "number": "1932817517",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1241 GOINS RD",
            "city": "PEMBROKE",
            "state": "NC",
            "postal_code": "283728347",
            "telephone_number": "910-827-7973"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1241 GOINS RD",
            "city": "PEMBROKE",
            "state": "NC",
            "postal_code": "283728347",
            "telephone_number": "910-827-7973"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KIMS ASSISTED LIVING LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-11-11",
        "last_updated": "2025-06-18",
        "certification_date": "2025-06-18",
        "status": "A",
        "authorized_official_last_name": "JACOBS",
        "authorized_official_first_name": "KIMBERLY",
        "authorized_official_middle_name": "DALE",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "910-536-2253",
        "authorized_official_credential": "LPN"
    },
    "taxonomies": [
        {
            "code": "311ZA0620X",
            "taxonomy_group": "",
            "desc": "Custodial Care Facility, Adult Care Home",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 18, 2025; 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.