Provider Demographics
NPI:1518413889
Name:KENTON HOUSING, INC.
Entity Type:Organization
Organization Name:KENTON HOUSING, INC.
Other - Org Name:EMERALD TRACE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:LONDA
Authorized Official - Middle Name:LEAH
Authorized Official - Last Name:KNOLLMAN
Authorized Official - Suffix:
Authorized Official - Credentials:LNHA
Authorized Official - Phone:859-431-2244
Mailing Address - Street 1:4250 GLENN AVENUE
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:41015
Mailing Address - Country:US
Mailing Address - Phone:859-431-2244
Mailing Address - Fax:859-431-7790
Practice Address - Street 1:3802 TURKEYFOOT ROAD
Practice Address - Street 2:
Practice Address - City:ELSMERE
Practice Address - State:KY
Practice Address - Zip Code:41018
Practice Address - Country:US
Practice Address - Phone:859-342-0200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:KENTON HOUSING, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-08-28
Last Update Date:2016-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility