Provider Demographics
NPI:1124816665
Name:SENIOR STAR TENANT KENWOOD, LLC
Entity type:Organization
Organization Name:SENIOR STAR TENANT KENWOOD, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:SHADOWOREE
Authorized Official - Middle Name:
Authorized Official - Last Name:BETTS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:918-592-4400
Mailing Address - Street 1:1516 S BOSTON AVE STE 301
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74119-4019
Mailing Address - Country:US
Mailing Address - Phone:918-592-4400
Mailing Address - Fax:
Practice Address - Street 1:5435 KENWOOD RD
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45227-1328
Practice Address - Country:US
Practice Address - Phone:513-561-9300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-04-25
Last Update Date:2025-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility