Provider Demographics
NPI:1457382194
Name:KENT'S ASSISTED LIVING
Entity Type:Organization
Organization Name:KENT'S ASSISTED LIVING
Other - Org Name:SHERRY KENT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR/OWNER/DIRECT CARE
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHERRY
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:KENT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:810-639-3378
Mailing Address - Street 1:8425 FARRAND RD
Mailing Address - Street 2:
Mailing Address - City:MONTROSE
Mailing Address - State:MI
Mailing Address - Zip Code:48457-9779
Mailing Address - Country:US
Mailing Address - Phone:810-639-3378
Mailing Address - Fax:810-639-3390
Practice Address - Street 1:8425 FARRAND RD
Practice Address - Street 2:
Practice Address - City:MONTROSE
Practice Address - State:MI
Practice Address - Zip Code:48457-9779
Practice Address - Country:US
Practice Address - Phone:810-639-3378
Practice Address - Fax:810-639-3390
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-05
Last Update Date:2010-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIAM250015926320600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities