Provider Demographics
NPI:1356864474
Name:TRILOGY HEALTHCARE OF KENT LLC
Entity Type:Organization
Organization Name:TRILOGY HEALTHCARE OF KENT LLC
Other - Org Name:THE OAKS AT BYRON CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SR. VP & CHIEF LEGAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:CRISTINA
Authorized Official - Middle Name:
Authorized Official - Last Name:PEITROWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:502-412-5847
Mailing Address - Street 1:PO BOX 221648
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40252-1648
Mailing Address - Country:US
Mailing Address - Phone:502-412-5847
Mailing Address - Fax:
Practice Address - Street 1:2280 BYRON VIEW DR SW
Practice Address - Street 2:
Practice Address - City:BYRON CENTER
Practice Address - State:MI
Practice Address - Zip Code:49315-7817
Practice Address - Country:US
Practice Address - Phone:616-949-7310
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TRILOGY INVESTORS LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-07-20
Last Update Date:2022-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI414370314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
235639OtherMEDICARE
MI8299729Medicaid