Provider Demographics
NPI:1144420597
Name:KENSINGTON ALGONQUIN, LLC.
Entity Type:Organization
Organization Name:KENSINGTON ALGONQUIN, LLC.
Other - Org Name:EVERGREEN ADULT DAY CARE
Other - Org Type:Other Name
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ELLEN
Authorized Official - Middle Name:
Authorized Official - Last Name:DASHIELL
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:301-777-2650
Mailing Address - Street 1:1 BALTIMORE ST
Mailing Address - Street 2:
Mailing Address - City:CUMBERLAND
Mailing Address - State:MD
Mailing Address - Zip Code:21502-2963
Mailing Address - Country:US
Mailing Address - Phone:301-777-2650
Mailing Address - Fax:
Practice Address - Street 1:1 BALTIMORE ST
Practice Address - Street 2:
Practice Address - City:CUMBERLAND
Practice Address - State:MD
Practice Address - Zip Code:21502-2963
Practice Address - Country:US
Practice Address - Phone:301-777-2650
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-24
Last Update Date:2007-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care