Healthcare Provider Details

I. General information

NPI: 1558455824
Provider Name (Legal Business Name): KENTON HEALTHCARE CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 02/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

353 WALLER AVE
LEXINGTON KY
40504-2901
US

IV. Provider business mailing address

7400 NEW LAGRANGE RD #100
LOUISVILLE KY
40222-4870
US

V. Phone/Fax

Practice location:
  • Phone: 859-252-3558
  • Fax: 859-233-0192
Mailing address:
  • Phone: 502-429-8062
  • Fax: 502-429-5980

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number100113
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code332BN1400X
TaxonomyNursing Facility Supplies (DME)
License Number100113
License Number StateKY
# 3
Primary TaxonomyN
Taxonomy Code332BP3500X
TaxonomyParenteral & Enteral Nutrition Supplies (DME)
License Number100113
License Number StateKY

VIII. Authorized Official

Name: MR. ALLEN CRAIG TSCHUDI
Title or Position: MANAGING MEMBER
Credential:
Phone: 502-429-8062