Provider Demographics
NPI:1699900183
Name:KC COMPANIES OF WORTHINGTON, INC
Entity type:Organization
Organization Name:KC COMPANIES OF WORTHINGTON, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KENT
Authorized Official - Middle Name:
Authorized Official - Last Name:MARTHALER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:320-217-2640
Mailing Address - Street 1:1790 COLLEGEWAY
Mailing Address - Street 2:
Mailing Address - City:WORTHINGTON
Mailing Address - State:MN
Mailing Address - Zip Code:56187-3113
Mailing Address - Country:US
Mailing Address - Phone:507-376-3111
Mailing Address - Fax:507-376-3311
Practice Address - Street 1:1790 COLLEGEWAY
Practice Address - Street 2:
Practice Address - City:WORTHINGTON
Practice Address - State:MN
Practice Address - Zip Code:56187-3113
Practice Address - Country:US
Practice Address - Phone:507-376-3111
Practice Address - Fax:507-376-3311
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-27
Last Update Date:2009-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN340040310400000X
MN341121310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility