Provider Demographics
NPI:1730735069
Name:K&G DEDICATED LONG-TERM CARE ASSOCIATES LLC
Entity type:Organization
Organization Name:K&G DEDICATED LONG-TERM CARE ASSOCIATES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/MD
Authorized Official - Prefix:
Authorized Official - First Name:KENRICK
Authorized Official - Middle Name:
Authorized Official - Last Name:RICHARDSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:513-843-7632
Mailing Address - Street 1:71 VISTA RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:SOUTH LEBANON
Mailing Address - State:OH
Mailing Address - Zip Code:45065-8755
Mailing Address - Country:US
Mailing Address - Phone:513-843-7716
Mailing Address - Fax:513-718-3223
Practice Address - Street 1:2155 DANA AVE
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45207-1340
Practice Address - Country:US
Practice Address - Phone:513-843-7716
Practice Address - Fax:513-718-3223
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-13
Last Update Date:2023-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalistGroup - Single Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty