Provider Demographics
NPI:1154189223
Name:KIMWEI, RUDIAH KWAMBOKA (CEO)
Entity type:Individual
Prefix:
First Name:RUDIAH
Middle Name:KWAMBOKA
Last Name:KIMWEI
Suffix:
Gender:F
Credentials:CEO
Other - Prefix:
Other - First Name:RUDIAH
Other - Middle Name:K
Other - Last Name:KIMWEI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:18259 EMBERS AVE
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:MN
Mailing Address - Zip Code:55024-9259
Mailing Address - Country:US
Mailing Address - Phone:612-978-3396
Mailing Address - Fax:
Practice Address - Street 1:18259 EMBERS AVE
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:MN
Practice Address - Zip Code:55024-9259
Practice Address - Country:US
Practice Address - Phone:612-978-3396
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-12
Last Update Date:2024-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385H00000XRespite Care FacilityRespite Care