Provider Demographics
NPI:1891519203
Name:KIM'S KORNER LLC
Entity type:Organization
Organization Name:KIM'S KORNER LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KIM
Authorized Official - Middle Name:
Authorized Official - Last Name:RICHARDSON
Authorized Official - Suffix:
Authorized Official - Credentials:EXECUTIVE DIRECTOR
Authorized Official - Phone:651-503-6573
Mailing Address - Street 1:1145 HUDSON RD
Mailing Address - Street 2:SUITE #228
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55106-4326
Mailing Address - Country:US
Mailing Address - Phone:651-503-6573
Mailing Address - Fax:
Practice Address - Street 1:1145 HUDSON RD APT 228
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55106-4326
Practice Address - Country:US
Practice Address - Phone:651-503-6573
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-12
Last Update Date:2024-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes172V00000XOther Service ProvidersCommunity Health WorkerGroup - Single Specialty