Basic Information
| Provider Information | |||||||||
| NPI: | 1386090850 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CRP KENSINGTON, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3715 NORTHSIDE PKWY NW | ||||||||
| Address2: | BUILDING 300, SUITE 110 | ||||||||
| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 303272882 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4042374509 | ||||||||
| FaxNumber: | 4042371719 | ||||||||
| Practice Location | |||||||||
| Address1: | 864 SHREWSBURY AVE | ||||||||
| Address2: | |||||||||
| City: | TINTON FALLS | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 077243074 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7327842400 | ||||||||
| FaxNumber: | 7325425978 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/13/2016 | ||||||||
| LastUpdateDate: | 05/13/2016 | ||||||||
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| AuthorizedOfficialLastName: | HARPER | ||||||||
| AuthorizedOfficialFirstName: | JUDSON | ||||||||
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| AuthorizedOfficialTitleorPosition: | MANAGEMENT AGENT | ||||||||
| AuthorizedOfficialTelephone: | 4042374509 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 310400000X | Y | Nursing & Custodial Care Facilities | Assisted Living Facility |
No ID Information.