MEDICARE: KENWOOD BUSINESS LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	310400000X	Assisted Living Facility

General Provider Information

NPI Number	:	1396430815
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KENWOOD BUSINESS LLC

Provider Business Mailing Address
First Line	:	607 E 1ST AVE
Second Line	:
City	:	ST JOHN
State	:	KS
Zip	:	67576-2223
Country	:	US
Telephone Number	:	214-606-0550
Fax Number	:

Provider Business Practice Location Address
First Line	:	607 E 1ST AVE
Second Line	:
City	:	ST JOHN
State	:	KS
Zip	:	67576-2223
Country	:	US
Telephone Number	:	214-606-0550
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	ASHER SYED HUSAIN
Credential	:
Telephone Number	:	214-606-0550

Provider Enumeration Date	:	04/10/2023
Last Update Date	:	04/10/2023

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Directions to “KENWOOD BUSINESS LLC ” Practice Location

Language	Start Address	Practice Location

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