Healthcare Provider Details

I. General information

NPI: 1790492437
Provider Name (Legal Business Name): KENSINGTON HEALTH CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/02/2022
Last Update Date: 11/02/2022
Certification Date: 11/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

225 ST. JOHN ROAD
ELIZABETHTOWN KY
42701
US

IV. Provider business mailing address

300 PROVIDER COURT
RICHMOND KY
40475
US

V. Phone/Fax

Practice location:
  • Phone: 270-769-3314
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: MAYER FISCHL
Title or Position: OWNER/MANAGING MEMBER
Credential:
Phone: 718-757-6399