Provider Demographics
NPI:1104299106
Name:KIMA'S CONGREGATE LIVING FACILITY, INC
Entity type:Organization
Organization Name:KIMA'S CONGREGATE LIVING FACILITY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ELMIRA
Authorized Official - Middle Name:
Authorized Official - Last Name:JAMALYAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:323-434-3737
Mailing Address - Street 1:43801 HALCOM AVE
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:CA
Mailing Address - Zip Code:93536-5819
Mailing Address - Country:US
Mailing Address - Phone:323-434-3737
Mailing Address - Fax:
Practice Address - Street 1:43801 HALCOM AVE
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:CA
Practice Address - Zip Code:93536-5819
Practice Address - Country:US
Practice Address - Phone:323-434-3737
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-12
Last Update Date:2015-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility