Provider Demographics
NPI:1548790322
Name:K & K ASSISTED LIVING, LLC
Entity Type:Organization
Organization Name:K & K ASSISTED LIVING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:MILTON
Authorized Official - Middle Name:LEWIS
Authorized Official - Last Name:KENNEDY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-231-3605
Mailing Address - Street 1:PO BOX 27560
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48227-0560
Mailing Address - Country:US
Mailing Address - Phone:313-915-7158
Mailing Address - Fax:
Practice Address - Street 1:16100 SUNDERLAND RD
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48219-4049
Practice Address - Country:US
Practice Address - Phone:313-693-9300
Practice Address - Fax:313-693-9301
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-14
Last Update Date:2017-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health