Basic Information
| Provider Information | |||||||||
| NPI: | 1851866768 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KIME | ||||||||
| FirstName: | JILLIAN | ||||||||
| MiddleName: | |||||||||
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| Credential: | MAED | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1104 SCARLET OAK DR | ||||||||
| Address2: | |||||||||
| City: | GREENVILLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 278588444 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9105907788 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 241 COMMERCE ST STE A | ||||||||
| Address2: | |||||||||
| City: | GREENVILLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 278585029 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2527141863 | ||||||||
| FaxNumber: | 2523643226 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/06/2018 | ||||||||
| LastUpdateDate: | 10/06/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251C00000X | 2018374059 | NC | Y | Agencies | Day Training, Developmentally Disabled Services |
No ID Information.