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NPI Code Detail

MEDICARE: K&G DEDICATED LONG-TERM CARE ASSOCIATES LLC

MEDICARE: K&G DEDICATED LONG-TERM CARE ASSOCIATES 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
1207R00000XInternal Medicine Physician
2208M00000XHospitalist Physician

General Provider Information

NPI Number : 1730735069
Entity Type Code : Organization
Provider Name (Legal Business Name) : K&G DEDICATED LONG-TERM CARE ASSOCIATES LLC
Provider Business Mailing Address
First Line : 71 VISTA RIDGE DR
Second Line :
City : SOUTH LEBANON
State : OH
Zip : 45065-8755
Country : US
Telephone Number : 513-843-7716
Fax Number : 513-718-3223
Provider Business Practice Location Address
First Line : 2155 DANA AVE
Second Line :
City : CINCINNATI
State : OH
Zip : 45207-1340
Country : US
Telephone Number : 513-843-7716
Fax Number : 513-718-3223
Authorized Official
Title or Position : PRESIDENT/MD
Name : KENRICK RICHARDSON
Credential : MD
Telephone Number : 513-843-7632
Provider Enumeration Date : 08/13/2019
Last Update Date : 03/14/2023

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Directions to “K&G DEDICATED LONG-TERM CARE ASSOCIATES LLC ” Practice Location

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