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General NPI Number Information
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NPI Number | 1265559280
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Entity Type | Organization
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Legal Business Name | KENNETT RESIDENTIAL CARE FACILITY II INC
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Dates
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Enumeration Date | 03/23/2007
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Last Update Date | 07/07/2008
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Provider Practice Location Address
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Address Line | 919 S JACKSON ST
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City | KENNETT
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State | MO
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Zip | 63857-3803
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Country | US
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Telephone | 573-888-1201
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Fax | 573-888-0114
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Provider Business Mailing Address
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Address Line | 919 S JACKSON ST
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City | KENNETT
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State | MO
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Zip | 63857-3803
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Country | US
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Telephone | 573-888-1201
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Fax | 573-888-0114
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Authorized Official
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Title or Position | OWNER PRESIDENT
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Name | MRS. GINA DAWN STOVERINK
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Credential |
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Telephone | 573-888-1201
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number | 032637
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License Number State | MO
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