Basic Information
| Provider Information | |||||||||
| NPI: | 1023039872 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | KINDRED NURSING CENTERS WEST, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 680 S 4TH ST | ||||||||
| Address2: | |||||||||
| City: | LOUISVILLE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 402022407 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5025967301 | ||||||||
| FaxNumber: | 5025964134 | ||||||||
| Practice Location | |||||||||
| Address1: | 11411 BRIDGEPORT WAY SW | ||||||||
| Address2: | |||||||||
| City: | LAKEWOOD | ||||||||
| State: | WA | ||||||||
| PostalCode: | 984993006 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2535819002 | ||||||||
| FaxNumber: | 2535817016 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/21/2006 | ||||||||
| LastUpdateDate: | 10/18/2017 | ||||||||
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| AuthorizedOfficialLastName: | WEAVER | ||||||||
| AuthorizedOfficialFirstName: | MARILYN | ||||||||
| AuthorizedOfficialMiddleName: | A. | ||||||||
| AuthorizedOfficialTitleorPosition: | ASSISTANT SECRETARY | ||||||||
| AuthorizedOfficialTelephone: | 5025967300 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 314000000X | 1256 | WA | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
ID Information
| ID | Type | State | Issuer | Description | 505347 | 01 | WA | TRICARE FOR LIFE | OTHER | 505347 | 01 | WA | REGENCE BLUE SHIELD | OTHER | 505347 | 01 | WA | TRIWEST ALLIANCE | OTHER | 69308 | 01 | WA | WA STATE LABOR & INDUSTRY | OTHER | 4112561 | 05 | WA | MEDICAID | 505347 | 01 | WA | PREMERA BLUE CROSS | OTHER | 505347 | 01 | WA | AETNA | OTHER | 505347 | 01 | WA | SECURE HORIZONS | OTHER | 505347 | 01 | WA | CHAMP VA | OTHER |