Provider Demographics
NPI:1407348196
Name:KENWOOD OPERATIONS, LLC
Entity type:Organization
Organization Name:KENWOOD OPERATIONS, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER / PRESIDENT & CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:D
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, MPH, MBA, CNIM
Authorized Official - Phone:224-733-6150
Mailing Address - Street 1:220 SHERWOOD DR
Mailing Address - Street 2:
Mailing Address - City:BENTON
Mailing Address - State:LA
Mailing Address - Zip Code:71006-9727
Mailing Address - Country:US
Mailing Address - Phone:224-733-6150
Mailing Address - Fax:
Practice Address - Street 1:220 SHERWOOD DR
Practice Address - Street 2:
Practice Address - City:BENTON
Practice Address - State:LA
Practice Address - Zip Code:71006-9727
Practice Address - Country:US
Practice Address - Phone:224-733-6150
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-30
Last Update Date:2024-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246ZE0600XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherElectroneurodiagnosticGroup - Multi-Specialty
No305S00000XManaged Care OrganizationsPoint of Service
No3336M0002XSuppliersPharmacyMail Order Pharmacy
No335E00000XSuppliersProsthetic/Orthotic SupplierGroup - Multi-Specialty