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Organization

AHSL KENTWOOD OPERATIONS, LLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
ROBERT GILLETTE NHA (CHIEF OPERATING OFFICE)
(248) 203-1800
Entity
Organization

Contact information

Practice address
5980 EASTERN AVE SE, KENTWOOD, MI 49508-6215
(616) 455-7087
Mailing address
6755 TELEGRAPH RD STE 330, BLOOMFIELD HILLS, MI 48301-3182
(248) 203-1800
(248) 203-2929

Taxonomy

Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
AL 410365134
MH
310400000X
Assisted Living Facility
Primary
AL 410365140
MI
311500000X
Alzheimer Center (Dementia Center)
AL 410364896
MI

Other

Enumeration date
10/09/2014
Last updated
10/09/2014
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