Organization
KGC OPERATOR, INC.
Active
Other names
Wynwood of Vernon
Organization subpart
No
Provider details
NPI number
Authorized official
MARK OHLENDORF (CO-PRESIDENT)
(414) 918-5000
Entity
Organization
Contact information
Practice address
4501 COLLEGE DR, VERNON, TX 76384-4093
(940) 552-8181
Mailing address
6737 W WASHINGTON ST, SUITE 2300, MILWAUKEE, WI 53214-5647
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
001004636
—
TX
Enumeration date
12/29/2006
Last updated
06/13/2008
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