Provider Demographics
NPI:1336283589
Name:KENWOOD HEARING CENTER, INC
Entity Type:Organization
Organization Name:KENWOOD HEARING CENTER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:
Authorized Official - Last Name:REIGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:419-534-3111
Mailing Address - Street 1:3450 W CENTRAL AVE STE 134
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43606-1403
Mailing Address - Country:US
Mailing Address - Phone:419-534-3111
Mailing Address - Fax:439-534-3113
Practice Address - Street 1:3450 W CENTRAL AVE STE 134
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43606-1403
Practice Address - Country:US
Practice Address - Phone:419-534-3111
Practice Address - Fax:439-534-3113
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0915102Medicaid
OH0915102Medicaid