Provider Demographics
NPI:1124835723
Name:KENT OH HEALTH & REHAB OPCO LLC
Entity type:Organization
Organization Name:KENT OH HEALTH & REHAB OPCO LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:PRUITT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-288-4029
Mailing Address - Street 1:1290 FAIRCHILD AVE
Mailing Address - Street 2:
Mailing Address - City:KENT
Mailing Address - State:OH
Mailing Address - Zip Code:44240-1814
Mailing Address - Country:US
Mailing Address - Phone:330-678-4912
Mailing Address - Fax:
Practice Address - Street 1:1290 FAIRCHILD AVE
Practice Address - Street 2:
Practice Address - City:KENT
Practice Address - State:OH
Practice Address - Zip Code:44240-1814
Practice Address - Country:US
Practice Address - Phone:330-678-4912
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-12-17
Last Update Date:2024-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility