Basic Information
Provider Information | |||||||||
NPI: | 1245826254 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | KINDRED HOSPITALS EAST, LLC | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: | KINDRED HOSPITAL PHILADELPHIA - HAVERTOWN (ACUTE REHAB UNIT) | ||||||||
OtherOrganizationType: | 3 | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 2000 OLD WEST CHESTER PIKE | ||||||||
Address2: |   | ||||||||
City: | HAVERTOWN | ||||||||
State: | PA | ||||||||
PostalCode: | 190832712 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 6105362100 | ||||||||
FaxNumber: |   | ||||||||
Practice Location | |||||||||
Address1: | 2000 OLD WEST CHESTER PIKE | ||||||||
Address2: |   | ||||||||
City: | HAVERTOWN | ||||||||
State: | PA | ||||||||
PostalCode: | 190832712 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 6105362100 | ||||||||
FaxNumber: |   | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 12/14/2020 | ||||||||
LastUpdateDate: | 03/24/2022 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | TEAGUE | ||||||||
AuthorizedOfficialFirstName: | KATHY | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: | VICE PRESIDENT, CORPORATE SECRETARY | ||||||||
AuthorizedOfficialTelephone: | 6292535121 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | N | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 03/24/2022 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 273Y00000X |   |   | Y |   | Hospital Units | Rehabilitation Unit |   |
ID Information
ID | Type | State | Issuer | Description | 120101 | 01 | PA | HOSPITAL LICENSE | OTHER |