Basic Information
Provider Information
NPI: 1427311356
EntityType: 2
ReplacementNPI:  
OrganizationName: KINDRED HOSPITALS EAST, LLC
LastName:  
FirstName:  
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName: KINDRED HOSPITAL - ST. LOUIS AT MERCY
OtherOrganizationType: 3
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 680 S 4TH ST
Address2: KL-5 REIMBURSEMENT
City: LOUISVILLE
State: KY
PostalCode: 402022407
CountryCode: US
TelephoneNumber: 5025967220
FaxNumber: 5025964134
Practice Location
Address1: 615 S NEW BALLAS RD
Address2: 7TH FLOOR
City: SAINT LOUIS
State: MO
PostalCode: 631418221
CountryCode: US
TelephoneNumber: 3145674626
FaxNumber: 3145674463
Other Information
ProviderEnumerationDate: 06/15/2012
LastUpdateDate: 09/22/2016
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode:  
AuthorizedOfficialLastName: WEAVER
AuthorizedOfficialFirstName: MARILYN
AuthorizedOfficialMiddleName: A.
AuthorizedOfficialTitleorPosition: ASSISTANT SECRETARY
AuthorizedOfficialTelephone: 5025967563
IsSoleProprietor:  
IsOrganizationSubpart: N
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
282E00000X  Y HospitalsLong Term Care Hospital 

No ID Information.


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