1457382194 NPI number — KENT'S ASSISTED LIVING

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1457382194 NPI number — KENT'S ASSISTED LIVING

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
KENT'S ASSISTED LIVING
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
SHERRY KENT
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1457382194
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/16/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8425 FARRAND RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MONTROSE
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48457-9779
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
810-639-3378
Provider Business Mailing Address Fax Number:
810-639-3390

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8425 FARRAND RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MONTROSE
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48457-9779
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
810-639-3378
Provider Business Practice Location Address Fax Number:
810-639-3390
Provider Enumeration Date:
07/05/2006

Additional Information

Authorized Official

Authorized Official Last Name:
KENT
Authorized Official First Name:
SHERRY
Authorized Official Middle Name:
MARIE
Authorized Official Title or Position:
ADMINISTRATOR/OWNER/DIRECT CARE
Authorized Official Telephone Number:
810-639-3378

Provider Taxonomy Codes

  • Taxonomy code: 320600000X , with the licence number:  AM250015926 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2024 www.npivalidator.com