Basic Information
| Provider Information | |||||||||
| NPI: | 1033127113 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | KINDRED NURSING CENTERS WEST, LLC | ||||||||
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| OtherOrganizationName: | KINDRED NURSING AND REHABILITATION - PARKVIEW | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 680 S 4TH ST # KH-2 | ||||||||
| Address2: | |||||||||
| City: | LOUISVILLE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 402022407 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 200 N OREGON ST | ||||||||
| Address2: | |||||||||
| City: | DILLON | ||||||||
| State: | MT | ||||||||
| PostalCode: | 597253624 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4066835105 | ||||||||
| FaxNumber: | 4066836388 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/04/2006 | ||||||||
| LastUpdateDate: | 12/12/2017 | ||||||||
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| AuthorizedOfficialLastName: | WEAVER | ||||||||
| AuthorizedOfficialFirstName: | MARILYN | ||||||||
| AuthorizedOfficialMiddleName: | A | ||||||||
| AuthorizedOfficialTitleorPosition: | ASSISTANT SECRETARY | ||||||||
| AuthorizedOfficialTelephone: | 5025967563 | ||||||||
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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 | 9914 | MT | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
ID Information
| ID | Type | State | Issuer | Description | 60928 | 01 | MO | BLUE CROSS/BLUE SHIELD PT | OTHER | 41492 | 01 | MT | BLUE CROSS/BLUE SHIELD | OTHER | 31-0471 | 05 | MT | MEDICAID | 661200 | 01 | MT | BLUE CROSS/BLUE SHIELD OT | OTHER | 661190 | 01 | MT | BLUE CROSS/BLUE SHIELD ST | OTHER |