Provider Demographics
NPI:1376157446
Name:KENAI RIVER HOLDINGS LLC
Entity Type:Organization
Organization Name:KENAI RIVER HOLDINGS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-CEO
Authorized Official - Prefix:
Authorized Official - First Name:CURTIS
Authorized Official - Middle Name:
Authorized Official - Last Name:RODRIGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-608-4065
Mailing Address - Street 1:16885 W BERNARDO DR STE 216
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92127-1620
Mailing Address - Country:US
Mailing Address - Phone:858-798-5700
Mailing Address - Fax:
Practice Address - Street 1:790 HOLMES ST
Practice Address - Street 2:
Practice Address - City:LIVERMORE
Practice Address - State:CA
Practice Address - Zip Code:94550-4229
Practice Address - Country:US
Practice Address - Phone:925-583-5777
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-04
Last Update Date:2020-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility