Provider Demographics
NPI:1942427299
Name:KENT, ERROLL LESLIE
Entity Type:Individual
Prefix:
First Name:ERROLL
Middle Name:LESLIE
Last Name:KENT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2395
Mailing Address - Street 2:
Mailing Address - City:STREETSBORO
Mailing Address - State:OH
Mailing Address - Zip Code:44241-0395
Mailing Address - Country:US
Mailing Address - Phone:330-524-7259
Mailing Address - Fax:
Practice Address - Street 1:3017 SHELLY RD
Practice Address - Street 2:
Practice Address - City:RAVENNA
Practice Address - State:OH
Practice Address - Zip Code:44266-9415
Practice Address - Country:US
Practice Address - Phone:330-388-9653
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide