Basic Information
| Provider Information | |||||||||
| NPI: | 1134230899 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | KINDRED NURSING CENTERS WEST, LLC | ||||||||
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| OtherOrganizationName: | KINDRED TRANSITIONAL CARE AND REHABILITATION - GREENBRIAR | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 680 S. FOURTH STREET | ||||||||
| Address2: | |||||||||
| City: | LOUISVILLE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 402022407 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5025966505 | ||||||||
| FaxNumber: | 5025964134 | ||||||||
| Practice Location | |||||||||
| Address1: | 55 HARRIS RD | ||||||||
| Address2: | |||||||||
| City: | NASHUA | ||||||||
| State: | NH | ||||||||
| PostalCode: | 030622145 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6038881573 | ||||||||
| FaxNumber: | 6038885089 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/31/2006 | ||||||||
| LastUpdateDate: | 09/15/2017 | ||||||||
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| AuthorizedOfficialLastName: | WEAVER | ||||||||
| AuthorizedOfficialFirstName: | MARILYN | ||||||||
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| AuthorizedOfficialTitleorPosition: | ASSISTANT SECRETARY | ||||||||
| AuthorizedOfficialTelephone: | 5025967300 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 314000000X | 02603 | NH | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
ID Information
| ID | Type | State | Issuer | Description | 903295 | 01 | NH | HPHC | OTHER | 4437758 | 01 | NH | AETNA | OTHER | 668612 | 01 | NH | UNITED HEALTH CARE | OTHER | 30011351 | 05 | NH | MEDICAID |