Organization
KIMBERLY HOME
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CHARLMAYNE SEABERRY ALSTON (CHIEF EXECUTIVE OFFICER)
(919) 798-8638
Entity
Organization
Contact information
Practice address
6701 LITCHFORD RD, RALEIGH, NC 27615-7112
(919) 798-8638
(919) 872-5412
Mailing address
1733 HODGE RD, KNIGHTDALE, NC 27545-9588
(919) 872-5412
(919) 872-5412
Taxonomy
Speciality
Code
Description
License number
State
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
Primary
MHL092633
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7805399
—
NC
Enumeration date
08/04/2008
Last updated
08/04/2008
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