Provider Demographics
NPI:1477542843
Name:KENYON SUNSET HOME
Entity Type:Organization
Organization Name:KENYON SUNSET HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CONTROLLER
Authorized Official - Prefix:
Authorized Official - First Name:DENISE
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:BUDD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:507-789-7103
Mailing Address - Street 1:127 GUNDERSON BLVD
Mailing Address - Street 2:
Mailing Address - City:KENYON
Mailing Address - State:MN
Mailing Address - Zip Code:55946-1014
Mailing Address - Country:US
Mailing Address - Phone:507-789-7103
Mailing Address - Fax:507-789-8843
Practice Address - Street 1:127 GUNDERSON BLVD
Practice Address - Street 2:
Practice Address - City:KENYON
Practice Address - State:MN
Practice Address - Zip Code:55946-1014
Practice Address - Country:US
Practice Address - Phone:507-789-7103
Practice Address - Fax:507-789-8843
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN245379Medicare ID - Type UnspecifiedMEDICARE