Organization · NPI-2

1217 Kenwood LLC

Assisted Living Facility · Mesa, AZ

NPI number1982464095
StatusActive
Last updated in NPPESSep 20, 2024

Details

NPI
1982464095
Entity type
Organization (NPI-2)
Legal business name
1217 Kenwood LLC
Organization subpart
Yes
Enumeration date
Mar 19, 2024
Certification date
Sep 20, 2024
Last updated
Sep 20, 2024

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
310400000X Assisted Living Facility––Yes

Other names

  • Minnie Lee'S Senior Home Care (Doing Business As)

Practice location

1217 E Kenwood St
Mesa, AZ 85203

Phone 480-646-2414

Mailing address

1217 E Kenwood St
Mesa, AZ 85203

Phone 480-646-2414

Authorized official

Ladonna Edgington
Owner/Operator
4806462414

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