Healthcare Provider Details

I. General information

NPI: 1730735069
Provider Name (Legal Business Name): K&G DEDICATED LONG-TERM CARE ASSOCIATES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/13/2019
Last Update Date: 03/14/2023
Certification Date: 03/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2155 DANA AVE
CINCINNATI OH
45207-1340
US

IV. Provider business mailing address

71 VISTA RIDGE DR
SOUTH LEBANON OH
45065-8755
US

V. Phone/Fax

Practice location:
  • Phone: 513-843-7716
  • Fax: 513-718-3223
Mailing address:
  • Phone: 513-843-7716
  • Fax: 513-718-3223

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number
License Number State

VIII. Authorized Official

Name: KENRICK RICHARDSON
Title or Position: PRESIDENT/MD
Credential: MD
Phone: 513-843-7632