1023039872 NPI number — KINDRED NURSING CENTERS WEST, LLC

Table of content: (NPI 1023039872)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1023039872 NPI number — KINDRED NURSING CENTERS WEST, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
KINDRED NURSING CENTERS WEST, 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:
1023039872
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/18/2017
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:
502-596-7301
Provider Business Mailing Address Fax Number:
502-596-4134

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11411 BRIDGEPORT WAY SW
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAKEWOOD
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98499-3006
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-581-9002
Provider Business Practice Location Address Fax Number:
253-581-7016
Provider Enumeration Date:
07/21/2006

Additional Information

Authorized Official

Authorized Official Last Name:
WEAVER
Authorized Official First Name:
MARILYN
Authorized Official Middle Name:
A.
Authorized Official Title or Position:
ASSISTANT SECRETARY
Authorized Official Telephone Number:
502-596-7300

Provider Taxonomy Codes

  • Taxonomy code: 314000000X , with the licence number:  1256 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 505347 . This is a "TRICARE FOR LIFE" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 505347 . This is a "REGENCE BLUE SHIELD" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 505347 . This is a "TRIWEST ALLIANCE" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 69308 . This is a "WA STATE LABOR & INDUSTRY" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 4112561 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 505347 . This is a "PREMERA BLUE CROSS" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 505347 . This is a "AETNA" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 505347 . This is a "SECURE HORIZONS" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 505347 . This is a "CHAMP VA" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".




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