1217 Kenwood LLC

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

Legal business name

1217 KENWOOD LLC

Doing business as

Minnie Lee's Senior Home Care

Practice address

1217 E Kenwood St
Mesa, AZ 85203

Phone

(480) 646-2414

NPI assigned

Mar 19, 2024

Last updated

Sep 20, 2024By the provider in NPPES

Organization subpart

Yes

Parent organization

1217 KENWOOD LLCAs reported in NPPES

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

Authorized official

Name

Ladonna Edgington

Title

Owner/Operator

Phone

(480) 646-2414

Specialties & licenses 1

Addresses

Other names 1

• Minnie Lee's Senior Home Care Doing business as

Part of

1217 Kenwood LLC

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

{
    "created_epoch": "1710806400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1726790400000",
    "number": "1982464095",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1217 E KENWOOD ST",
            "city": "MESA",
            "state": "AZ",
            "postal_code": "85203",
            "telephone_number": "480-646-2414"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1217 E KENWOOD ST",
            "city": "MESA",
            "state": "AZ",
            "postal_code": "85203",
            "telephone_number": "480-646-2414"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "1217 KENWOOD LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "1217 KENWOOD LLC",
        "enumeration_date": "2024-03-19",
        "last_updated": "2024-09-20",
        "certification_date": "2024-09-20",
        "status": "A",
        "authorized_official_last_name": "EDGINGTON",
        "authorized_official_first_name": "LADONNA",
        "authorized_official_title_or_position": "OWNER/OPERATOR",
        "authorized_official_telephone_number": "480-646-2414"
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Minnie Lee's Senior Home Care",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Assisted Living Facility in Mesa, AZ
• Providers in Mesa, AZ by specialty
• Assisted Living Facility in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 20, 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.