Healthcare Provider Details

I. General information

NPI: 1144420597
Provider Name (Legal Business Name): KENSINGTON ALGONQUIN, LLC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/24/2007
Last Update Date: 07/24/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 BALTIMORE ST
CUMBERLAND MD
21502-2963
US

IV. Provider business mailing address

1 BALTIMORE ST
CUMBERLAND MD
21502-2963
US

V. Phone/Fax

Practice location:
  • Phone: 301-777-2650
  • Fax:
Mailing address:
  • Phone: 301-777-2650
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ELLEN DASHIELL
Title or Position: DIRECTOR
Credential: RN
Phone: 301-777-2650