Basic Information
| Provider Information | |||||||||
| NPI: | 1356639850 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | KND DEVELOPMENT 59 LLC | ||||||||
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| OtherOrganizationName: | 4859 KH HOUSTON NORTH | ||||||||
| OtherOrganizationType: | 5 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 680 S 4TH ST | ||||||||
| Address2: | |||||||||
| City: | LOUISVILLE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 402022407 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5025967300 | ||||||||
| FaxNumber: | 5025964150 | ||||||||
| Practice Location | |||||||||
| Address1: | 7407 NORTH FWY | ||||||||
| Address2: | |||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 770761314 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8322006000 | ||||||||
| FaxNumber: | 5025964150 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/18/2011 | ||||||||
| LastUpdateDate: | 02/08/2016 | ||||||||
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| AuthorizedOfficialLastName: | FURGERSON | ||||||||
| AuthorizedOfficialFirstName: | JOSHUA | ||||||||
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| AuthorizedOfficialTitleorPosition: | DVP REVENUE CYCLE HD | ||||||||
| AuthorizedOfficialTelephone: | 5025966463 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | KINDRED HEALTHCARE, LLC | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208M00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Hospitalist |
ID Information
| ID | Type | State | Issuer | Description | 343703 | 01 | TX | MEDICARE | OTHER |