Provider Demographics
NPI:1063599538
Name:KIMBERLY'S RESIDENTIAL CARE HOME
Entity type:Organization
Organization Name:KIMBERLY'S RESIDENTIAL CARE HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MIKE
Authorized Official - Middle Name:G
Authorized Official - Last Name:TAMPUS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:916-631-7969
Mailing Address - Street 1:2218 BUCKS CREEK CT
Mailing Address - Street 2:
Mailing Address - City:GOLD RIVER
Mailing Address - State:CA
Mailing Address - Zip Code:95670-8121
Mailing Address - Country:US
Mailing Address - Phone:916-631-7969
Mailing Address - Fax:916-638-8880
Practice Address - Street 1:10514 MILLS TOWER DR
Practice Address - Street 2:
Practice Address - City:RANCHO CORDOVA
Practice Address - State:CA
Practice Address - Zip Code:95670-5517
Practice Address - Country:US
Practice Address - Phone:916-362-4473
Practice Address - Fax:916-362-4473
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA320800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness