1215941828 NPI number — KINDRED NURSING CENTERS LIMITED PARTNERSHIP

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1215941828 NPI number — KINDRED NURSING CENTERS LIMITED PARTNERSHIP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
KINDRED NURSING CENTERS LIMITED PARTNERSHIP
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:
1215941828
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/15/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
680 S. FOURTH 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:
502-596-6505
Provider Business Mailing Address Fax Number:
502-596-4134

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
515 GREENE DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GREENVILLE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
42345-1409
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
270-338-5400
Provider Business Practice Location Address Fax Number:
270-338-0507
Provider Enumeration Date:
07/28/2006

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:
502-596-7563

Provider Taxonomy Codes

  • Taxonomy code: 314000000X , with the licence number:  100343 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 000000054431 . This is a "ANTHEM BCBS OF KY" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 33128 . This is a "HEALTH NETWORK CENTRAL" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 1174958 . This is a "CHA PROVIDER NETWORK" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 12503611 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".




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