MEDICARE: KC COMPANIES OF TOWER INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	310400000X	Assisted Living Facility

General Provider Information

NPI Number	:	1568650307
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KC COMPANIES OF TOWER INC

Provider Business Mailing Address
First Line	:	1232 BIRCH ST N
Second Line	:
City	:	TOWER
State	:	MN
Zip	:	55790-8226
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1232 BIRCH ST N
Second Line	:
City	:	TOWER
State	:	MN
Zip	:	55790-8226
Country	:	US
Telephone Number	:	218-753-7788
Fax Number	:

Authorized Official
Title or Position	:	ACCTG DEPT MANAGEMENT DEPT FOR KC
Name	:	BERNICE RUTH PHELPS
Credential	:
Telephone Number	:	320-217-2640

Provider Enumeration Date	:	10/05/2007
Last Update Date	:	07/16/2008

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