Healthcare Provider Details

I. General information

NPI: 1902728322
Provider Name (Legal Business Name): KENNEDI PLACE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/28/2026
Last Update Date: 07/28/2026
Certification Date: 07/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1131 1ST ST
FAIRFIELD CA
94533-4729
US

IV. Provider business mailing address

1131 1ST ST
FAIRFIELD CA
94533-4729
US

V. Phone/Fax

Practice location:
  • Phone: 707-704-2408
  • Fax:
Mailing address:
  • Phone: 707-704-2408
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State

VIII. Authorized Official

Name: ROMOANETIA LOFTON
Title or Position: ADMINISTRATOR
Credential: DNP, FNP-BC
Phone: 707-704-2408