1811668437 NPI number — KINDRED BH ACQUISITION 3, LLC

Table of content: (NPI 1811668437)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1811668437 NPI number — KINDRED BH ACQUISITION 3, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
KINDRED BH ACQUISITION 3, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1811668437
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/23/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
680 S 4TH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LOUISVILLE
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
40202-2407
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
502-596-7220
Provider Business Mailing Address Fax Number:
502-596-4314

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
831 LANDON DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BULLHEAD CITY
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
86429-7674
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
928-404-6012
Provider Business Practice Location Address Fax Number:
928-404-2553
Provider Enumeration Date:
09/23/2021

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
DILLON
Authorized Official First Name:
TERRANCE
Authorized Official Middle Name:
K
Authorized Official Title or Position:
ASSISTANT SECRETARY / AO
Authorized Official Telephone Number:
502-596-7220

Provider Taxonomy Codes

  • Taxonomy code: 283Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)