Provider Demographics
NPI:1053647776
Name:KENSINGTON FORT MADISON, LLC
Entity Type:Organization
Organization Name:KENSINGTON FORT MADISON, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:RACHEL
Authorized Official - Middle Name:H
Authorized Official - Last Name:BENDA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:319-372-4233
Mailing Address - Street 1:2210 AVE H
Mailing Address - Street 2:
Mailing Address - City:FORT MADISON
Mailing Address - State:IA
Mailing Address - Zip Code:52627-4003
Mailing Address - Country:US
Mailing Address - Phone:319-372-4233
Mailing Address - Fax:319-372-7940
Practice Address - Street 1:2210 AVE H
Practice Address - Street 2:
Practice Address - City:FORT MADISON
Practice Address - State:IA
Practice Address - Zip Code:52627-4003
Practice Address - Country:US
Practice Address - Phone:319-372-4233
Practice Address - Fax:319-372-7940
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-30
Last Update Date:2009-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
S0092310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAX000417287Medicaid