Provider Demographics
NPI:1306823406
Name:KENWOOD PLAZA, INC.
Entity Type:Organization
Organization Name:KENWOOD PLAZA, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:TRACY
Authorized Official - Middle Name:L
Authorized Official - Last Name:BARTLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:785-273-3383
Mailing Address - Street 1:607 E 1ST AVE
Mailing Address - Street 2:
Mailing Address - City:ST JOHN
Mailing Address - State:KS
Mailing Address - Zip Code:67576-2223
Mailing Address - Country:US
Mailing Address - Phone:620-549-6133
Mailing Address - Fax:620-549-9971
Practice Address - Street 1:607 E 1ST AVE
Practice Address - Street 2:
Practice Address - City:ST JOHN
Practice Address - State:KS
Practice Address - Zip Code:67576-2223
Practice Address - Country:US
Practice Address - Phone:620-549-6133
Practice Address - Fax:620-549-9971
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSN093004310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility