Kenton Irvine
Individual provider Active NPI Assisted Living Facility · Ennis, MT
NPI 1689098253 · NPPES record last updated Feb 18, 2014
Key facts
- NPI
- 1689098253
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Assisted Living Facility 310400000X
- License
- 12601 (MT)
- Practice address
- 200 W Fagin St
Ennis, MT 59729-8923 - Phone
- (406) 539-7133
- NPI assigned
- Feb 18, 2014
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 12601 | MT | MD | Assisted Living Facility |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Generations | Assisted Living Facility | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Assisted Living Facility | 310400000X | 12601 | MT | Yes |
Addresses
Primary practice location
200 W Fagin St
Ennis, MT 59729-8923
Mailing address
200 W Fagin St
PO Box 160
Ennis, MT 59729-8923
Phone (406) 539-7133
Other providers in Ennis, MT
- Generations
- Lawrence Howard Grall
- Marie Lena Hajny
- Tara Hanel
- Lacey Hanson
- Teresa Marie Langsdale
- LD Counseling Services LLC
- Life Design Chiropractic, PLLC
- Madison County Finance
- Madison Dental PC
All providers in Ennis, MT · Assisted Living Facility in Montana
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 18, 2014. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.