1114256989 NPI number — KND DEVELOPMENT 59, LLC

Table of content: (NPI 1114256989)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1114256989 NPI number — KND DEVELOPMENT 59, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
KND DEVELOPMENT 59, 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:
6
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:
1114256989
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/23/2020
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:
502-596-7358
Provider Business Mailing Address Fax Number:
833-501-9731

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
400 W BLACKWELL ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DOVER
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07801-2525
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
973-537-3818
Provider Business Practice Location Address Fax Number:
502-596-4150
Provider Enumeration Date:
12/08/2009

Additional Information

Authorized Official

Authorized Official Last Name:
FISHER
Authorized Official First Name:
LINDA
Authorized Official Middle Name:
L
Authorized Official Title or Position:
DVP REVENUE CYCLE
Authorized Official Telephone Number:
502-596-7358

Provider Taxonomy Codes

  • Taxonomy code: 208M00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 569251 . This is a "MEDICARE" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".




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