Provider Demographics
NPI:1407440118
Name:WELL PATH TENANT, LLC
Entity Type:Organization
Organization Name:WELL PATH TENANT, LLC
Other - Org Name:CARRIAGE COURT OF KENWOOD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:AUTHORIZED AGENT
Authorized Official - Prefix:
Authorized Official - First Name:TARA
Authorized Official - Middle Name:
Authorized Official - Last Name:MARZEWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:312-948-4534
Mailing Address - Street 1:222 N. RIVERSIDE PLAZA
Mailing Address - Street 2:20TH FLOOR
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60606
Mailing Address - Country:US
Mailing Address - Phone:312-837-0710
Mailing Address - Fax:312-837-0728
Practice Address - Street 1:4650 E GALBRAITH RD
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45236-2792
Practice Address - Country:US
Practice Address - Phone:513-480-3529
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WELL PATH TENANT, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-02-23
Last Update Date:2023-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility