Provider Demographics
NPI:1215460787
Name:LOREN KENNEY
Entity type:Organization
Organization Name:LOREN KENNEY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RN
Authorized Official - Prefix:
Authorized Official - First Name:LOREN
Authorized Official - Middle Name:
Authorized Official - Last Name:KENNEY
Authorized Official - Suffix:
Authorized Official - Credentials:BSN
Authorized Official - Phone:334-803-6001
Mailing Address - Street 1:464 REMSEN RD
Mailing Address - Street 2:
Mailing Address - City:WADING RIVER
Mailing Address - State:NY
Mailing Address - Zip Code:11792-1747
Mailing Address - Country:US
Mailing Address - Phone:334-803-6001
Mailing Address - Fax:
Practice Address - Street 1:464 REMSEN RD
Practice Address - Street 2:
Practice Address - City:WADING RIVER
Practice Address - State:NY
Practice Address - Zip Code:11792-1747
Practice Address - Country:US
Practice Address - Phone:334-803-6001
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-11
Last Update Date:2017-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY655123311Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311Z00000XNursing & Custodial Care FacilitiesCustodial Care Facility