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General NPI Number Information
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NPI Number | 1386048080
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Entity Type | Organization
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Legal Business Name | AHSL KENTWOOD OPERATIONS, LLC
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Dates
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Enumeration Date | 10/09/2014
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Last Update Date | 10/09/2014
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Provider Practice Location Address
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Address Line | 5980 EASTERN AVE SE
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City | KENTWOOD
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State | MI
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Zip | 49508-6215
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Country | US
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Telephone | 616-455-7087
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Fax |
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Provider Business Mailing Address
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Address Line | 6755 TELEGRAPH RD STE 330
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City | BLOOMFIELD HILLS
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State | MI
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Zip | 48301-3182
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Country | US
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Telephone | 248-203-1800
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Fax | 248-203-2929
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Authorized Official
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Title or Position | CHIEF OPERATING OFFICE
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Name | ROBERT GILLETTE
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Credential | NHA
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Telephone | 248-203-1800
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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 | AL 410365134
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License Number State | MH
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Taxonomy #2
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Taxonomy Code | 311500000X
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Taxonomy Name | Alzheimer Center (Dementia Center)
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License Number | AL 410364896
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License Number State | MI
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Taxonomy #3
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number | AL 410365140
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License Number State | MI
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