Basic Information
| Provider Information | |||||||||
| NPI: | 1215941828 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | KINDRED NURSING CENTERS LIMITED PARTNERSHIP | ||||||||
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| OtherOrganizationName: | KINDRED NURSING AND REHABILITATION-MAPLE | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 680 S. FOURTH ST | ||||||||
| Address2: | |||||||||
| City: | LOUISVILLE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 402022407 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5025966505 | ||||||||
| FaxNumber: | 5025964134 | ||||||||
| Practice Location | |||||||||
| Address1: | 515 GREENE DR | ||||||||
| Address2: | |||||||||
| City: | GREENVILLE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 423451409 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2703385400 | ||||||||
| FaxNumber: | 2703380507 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/28/2006 | ||||||||
| LastUpdateDate: | 09/15/2017 | ||||||||
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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 | 100343 | KY | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
ID Information
| ID | Type | State | Issuer | Description | 000000054431 | 01 | KY | ANTHEM BCBS OF KY | OTHER | 33128 | 01 | KY | HEALTH NETWORK CENTRAL | OTHER | 1174958 | 01 | KY | CHA PROVIDER NETWORK | OTHER | 12503611 | 05 | KY | MEDICAID |