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General NPI Number Information
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NPI Number | 1730186305
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Entity Type | Organization
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Legal Business Name | INFINIA AT KENSINGTON
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Dates
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Enumeration Date | 06/28/2005
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Last Update Date | 06/12/2008
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Provider Practice Location Address
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Address Line | 613 N MAIN ST
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City | KENSINGTON
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State | KS
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Zip | 66951-0248
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Country | US
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Telephone | 785-476-2623
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Fax | 785-476-2620
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Provider Business Mailing Address
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Address Line | PO BOX 248
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City | KENSINGTON
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State | KS
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Zip | 66951-0248
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Country | US
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Telephone | 785-476-2623
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Fax | 785-476-2620
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Authorized Official
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Title or Position | OWNER
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Name | JON ROBERTSON
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Credential |
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Telephone | 801-296-5105
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number | N-092-002
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License Number State | KS
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