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General NPI Number Information
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NPI Number | 1699900183
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Entity Type | Organization
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Legal Business Name | KC COMPANIES OF WORTHINGTON, INC
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Dates
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Enumeration Date | 05/27/2009
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Last Update Date | 05/27/2009
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Provider Practice Location Address
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Address Line | 1790 COLLEGEWAY
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City | WORTHINGTON
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State | MN
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Zip | 56187-3113
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Country | US
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Telephone | 507-376-3111
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Fax | 507-376-3311
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Provider Business Mailing Address
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Address Line | 1790 COLLEGEWAY
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City | WORTHINGTON
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State | MN
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Zip | 56187-3113
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Country | US
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Telephone | 507-376-3111
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Fax | 507-376-3311
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Authorized Official
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Title or Position | PRESIDENT
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Name | KENT MARTHALER
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Credential |
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Telephone | 320-217-2640
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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 | 340040
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License Number State | MN
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Taxonomy #2
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number | 341121
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License Number State | MN
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