MEDICARE: KENT'S ASSISTED LIVING

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	320600000X	Intellectual and/or Developmental Disabilities Residential Treatment Facility	AM250015926	MI

General Provider Information

NPI Number	:	1457382194
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KENT'S ASSISTED LIVING

Provider Business Mailing Address
First Line	:	8425 FARRAND RD
Second Line	:
City	:	MONTROSE
State	:	MI
Zip	:	48457-9779
Country	:	US
Telephone Number	:	810-639-3378
Fax Number	:	810-639-3390

Provider Business Practice Location Address
First Line	:	8425 FARRAND RD
Second Line	:
City	:	MONTROSE
State	:	MI
Zip	:	48457-9779
Country	:	US
Telephone Number	:	810-639-3378
Fax Number	:	810-639-3390

Authorized Official
Title or Position	:	ADMINISTRATOR/OWNER/DIRECT CARE
Name	:	MRS. SHERRY MARIE KENT
Credential	:
Telephone Number	:	810-639-3378

Provider Enumeration Date	:	07/05/2006
Last Update Date	:	04/16/2010

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Directions to “KENT'S ASSISTED LIVING ” Practice Location

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