Healthcare Provider Details

I. General information

NPI: 1720077704
Provider Name (Legal Business Name): KENTON HOUSING, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/21/2005
Last Update Date: 06/13/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4250 GLENN AVE
COVINGTON KY
41015-1641
US

IV. Provider business mailing address

4250 GLENN AVE
COVINGTON KY
41015-1641
US

V. Phone/Fax

Practice location:
  • Phone: 859-431-2244
  • Fax: 859-431-7790
Mailing address:
  • Phone: 859-431-2244
  • Fax: 859-431-7790

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code313M00000X
TaxonomyNursing Facility/Intermediate Care Facility
License Number100269
License Number StateKY

VIII. Authorized Official

Name: MS. LONDA LEAH KNOLLMAN
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 859-431-2244