Basic Information
| Provider Information | |||||||||
| NPI: | 1811072341 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | KINDRED HOSPITALS EAST, LLC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | KINDRED HOSPITAL - SOUTH FLORIDA - HOLLYWOOD | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1859 VAN BUREN ST | ||||||||
| Address2: | |||||||||
| City: | HOLLYWOOD | ||||||||
| State: | FL | ||||||||
| PostalCode: | 330205127 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9549209000 | ||||||||
| FaxNumber: | 9549263887 | ||||||||
| Practice Location | |||||||||
| Address1: | 1859 VAN BUREN ST | ||||||||
| Address2: | |||||||||
| City: | HOLLYWOOD | ||||||||
| State: | FL | ||||||||
| PostalCode: | 330205127 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9549209000 | ||||||||
| FaxNumber: | 9549263887 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/25/2006 | ||||||||
| LastUpdateDate: | 03/21/2022 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | TEAGUE | ||||||||
| AuthorizedOfficialFirstName: | KATHY | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | VICE PRESIDENT, CORPORATE SECRETARY | ||||||||
| AuthorizedOfficialTelephone: | 6292535121 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 03/21/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 282N00000X | N | Hospitals | General Acute Care Hospital | 282E00000X | 4177 | FL | Y | Hospitals | Long Term Care Hospital |
ID Information
| ID | Type | State | Issuer | Description | 201 | 01 | FL | BLUE CROSS | OTHER | 010191500 | 05 | FL | MEDICAID |