Kettering Affiliated Health Services

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

License

1876R Issued in OH

Legal business name

KETTERING AFFILIATED HEALTH SERVICES

Doing business as

Sycamore Glen Retirement Community

Practice address

317 Sycamore Glen Dr
Miamisburg, OH 45342-5720

Phone

(937) 866-2984

Fax

(937) 866-7488

NPI assigned

Nov 11, 2013

Last updated

Aug 2, 2024By the provider in NPPES

Organization subpart

Yes

Parent organization

KETTERING AFFILIATED HEALTH SERVICESAs reported in NPPES

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

Authorized official

Name

Timothy Ko

Title

Kettering Health Cfo

Phone

(937) 558-3223

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Sycamore Glen Retirement Community Doing business as

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Part of

Kettering Affiliated Health

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

• Kettering Affiliated Health Services

  dba Kettering Breast Evaluation Center

  • Clinic/Center
  • Kettering, OH
  • NPI 1003919176
  NPPES parent name

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

{
    "created_epoch": "1384128000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1722556800000",
    "number": "1881023885",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "317 SYCAMORE GLEN DR",
            "city": "MIAMISBURG",
            "state": "OH",
            "postal_code": "453425720",
            "telephone_number": "937-866-2984",
            "fax_number": "937-866-7488"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "317 SYCAMORE GLEN DR",
            "city": "MIAMISBURG",
            "state": "OH",
            "postal_code": "453425720",
            "telephone_number": "937-866-2984",
            "fax_number": "937-866-7488"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KETTERING AFFILIATED HEALTH SERVICES",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "KETTERING AFFILIATED HEALTH SERVICES",
        "enumeration_date": "2013-11-11",
        "last_updated": "2024-08-02",
        "certification_date": "2024-08-02",
        "status": "A",
        "authorized_official_last_name": "KO",
        "authorized_official_first_name": "TIMOTHY",
        "authorized_official_title_or_position": "KETTERING HEALTH CFO",
        "authorized_official_telephone_number": "937-558-3223"
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "OH",
            "license": "1876R",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2676886",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Sycamore Glen Retirement Community",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Sycamore Glen Retirement Community",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Hillard Kelly III, LPN
• Yolonda M Kelly, NP
• Brittany Eileen Kemnetz, CPNP-PC
• Judith Eileen Kennedy
• Kettering Affiliated Health Services (Sycamore Glen Health Center)
• Kettering Independent Medical Group Inc
• Kettering Independent Medical Group Inc
• Kettering Medical Center (Collaborative Pharmacy Services)
• Kettering Medical Center (Kettering Health Miamisburg)
• Kettering Medical Center (Kettering Health Pharmacy Miamisburg)

• Assisted Living Facility in Miamisburg, OH
• Providers in Miamisburg, OH by specialty
• Assisted Living Facility in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 2, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.