Basic Information
| Provider Information | |||||||||
| NPI: | 1154935617 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | KENTON POINTE LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 909 KENTON STATION DR | ||||||||
| Address2: | |||||||||
| City: | MAYSVILLE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 410569616 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6067594050 | ||||||||
| FaxNumber: | 6067591207 | ||||||||
| Practice Location | |||||||||
| Address1: | 1455 KENTON POINTE WAY | ||||||||
| Address2: | |||||||||
| City: | MAYSVILLE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 410561195 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6067590311 | ||||||||
| FaxNumber: | 6067590317 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/02/2020 | ||||||||
| LastUpdateDate: | 09/02/2020 | ||||||||
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| AuthorizedOfficialLastName: | TROVATO | ||||||||
| AuthorizedOfficialFirstName: | ANTHONY | ||||||||
| AuthorizedOfficialMiddleName: | MARK | ||||||||
| AuthorizedOfficialTitleorPosition: | EXECUTIVE DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 6067594050 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | HOSPICE OF HOPE, INC | ||||||||
| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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| NPICertificationDate: | 09/02/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 310400000X | Y | Nursing & Custodial Care Facilities | Assisted Living Facility |
ID Information
| ID | Type | State | Issuer | Description | 20130808101 | 01 | KY | ASSISTED LIVING COMMUNITY CERTIFICATION | OTHER |