Kingston Residence of Fort Wayne, LLC

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

Legal business name

KINGSTON RESIDENCE OF FORT WAYNE, LLC

Practice address

7515 Winchester Rd
Fort Wayne, IN 46819-2257

Phone

(260) 747-1523

NPI assigned

Aug 8, 2024

Last updated

Aug 8, 2024By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Jessica Siu

Title

Director of Operations

Phone

(419) 392-8529

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1723075200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1723075200000",
    "number": "1316778780",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 SEAGATE STE 1960",
            "city": "TOLEDO",
            "state": "OH",
            "postal_code": "436041592",
            "telephone_number": "419-725-1938",
            "fax_number": "419-247-2872"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7515 WINCHESTER RD",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468192257",
            "telephone_number": "260-747-1523"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KINGSTON RESIDENCE OF FORT WAYNE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-08-08",
        "last_updated": "2024-08-08",
        "certification_date": "2024-08-08",
        "status": "A",
        "authorized_official_last_name": "SIU",
        "authorized_official_first_name": "JESSICA",
        "authorized_official_title_or_position": "DIRECTOR OF OPERATIONS",
        "authorized_official_telephone_number": "419-392-8529"
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Samantha Kay King, CNM, RN
• Samuel J. King II, M.D.
• Susan E King, AGPCNP-BC
• Tonisha M King, BA, MS.ED
• Winsome King
• David A Kiningham, M.ED
• Emeri C Kinnamon, NP
• Robert James Kinne, M.D.
• George H Kinnebrew, M.D.
• Cassandra Kinney, AU.D.

• Assisted Living Facility in Fort Wayne, IN
• Providers in Fort Wayne, IN by specialty
• Assisted Living Facility in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 8, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.