Provider Demographics
NPI:1730186305
Name:INFINIA AT KENSINGTON
Entity type:Organization
Organization Name:INFINIA AT KENSINGTON
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JON
Authorized Official - Middle Name:
Authorized Official - Last Name:ROBERTSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-296-5105
Mailing Address - Street 1:PO BOX 248
Mailing Address - Street 2:
Mailing Address - City:KENSINGTON
Mailing Address - State:KS
Mailing Address - Zip Code:66951-0248
Mailing Address - Country:US
Mailing Address - Phone:785-476-2623
Mailing Address - Fax:785-476-2620
Practice Address - Street 1:613 N MAIN ST
Practice Address - Street 2:
Practice Address - City:KENSINGTON
Practice Address - State:KS
Practice Address - Zip Code:66951-0248
Practice Address - Country:US
Practice Address - Phone:785-476-2623
Practice Address - Fax:785-476-2620
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-28
Last Update Date:2008-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSN-092-002314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS104202440Medicaid
KS104202440Medicaid