Provider Demographics
NPI:1386048080
Name:AHSL KENTWOOD OPERATIONS, LLC
Entity type:Organization
Organization Name:AHSL KENTWOOD OPERATIONS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATING OFFICE
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:GILLETTE
Authorized Official - Suffix:
Authorized Official - Credentials:NHA
Authorized Official - Phone:248-203-1800
Mailing Address - Street 1:6755 TELEGRAPH RD STE 330
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48301-3182
Mailing Address - Country:US
Mailing Address - Phone:248-203-1800
Mailing Address - Fax:248-203-2929
Practice Address - Street 1:5980 EASTERN AVE SE
Practice Address - Street 2:
Practice Address - City:KENTWOOD
Practice Address - State:MI
Practice Address - Zip Code:49508-6215
Practice Address - Country:US
Practice Address - Phone:616-455-7087
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-09
Last Update Date:2014-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIAL 410365140310400000X
MHAL 410365134310400000X
MIAL 410364896311500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
No311500000XNursing & Custodial Care FacilitiesAlzheimer Center (Dementia Center)