Provider Demographics
NPI:1700462199
Name:KENNY'S PERSONAL CARE HOME
Entity Type:Organization
Organization Name:KENNY'S PERSONAL CARE HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:KENYON
Authorized Official - Middle Name:
Authorized Official - Last Name:LINDSEY
Authorized Official - Suffix:
Authorized Official - Credentials:CEO, COUNSELOR
Authorized Official - Phone:770-899-2849
Mailing Address - Street 1:4043 BIG VALLEY TRL
Mailing Address - Street 2:
Mailing Address - City:STONE MOUNTAIN
Mailing Address - State:GA
Mailing Address - Zip Code:30083-5711
Mailing Address - Country:US
Mailing Address - Phone:770-676-0766
Mailing Address - Fax:770-676-0766
Practice Address - Street 1:4043 BIG VALLEY TRL
Practice Address - Street 2:
Practice Address - City:STONE MOUNTAIN
Practice Address - State:GA
Practice Address - Zip Code:30083-5711
Practice Address - Country:US
Practice Address - Phone:770-676-0766
Practice Address - Fax:770-676-0766
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-24
Last Update Date:2021-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
No251E00000XAgenciesHome Health
No251S00000XAgenciesCommunity/Behavioral Health
No253Z00000XAgenciesIn Home Supportive Care
No320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness