Provider Demographics
NPI:1063624542
Name:KIM KEMATS
Entity type:Organization
Organization Name:KIM KEMATS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:KEMATS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-420-9464
Mailing Address - Street 1:6971 ADAMS RD
Mailing Address - Street 2:
Mailing Address - City:ROGERS
Mailing Address - State:OH
Mailing Address - Zip Code:44455-9707
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7941 LISBON-SALEM ROAD
Practice Address - Street 2:APARTMENT D
Practice Address - City:LISBON
Practice Address - State:OH
Practice Address - Zip Code:44432
Practice Address - Country:US
Practice Address - Phone:330-420-9464
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-04
Last Update Date:2008-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1322698251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2351557Medicaid