Basic Information
| Provider Information | |||||||||
| NPI: | 1811150188 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | KINDRED NURSING CENTERS EAST LLC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | NEWARK HEALTHCARE CENTRE | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 75 MCMILLEN DR | ||||||||
| Address2: | |||||||||
| City: | NEWARK | ||||||||
| State: | OH | ||||||||
| PostalCode: | 430551808 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7403440357 | ||||||||
| FaxNumber: | 7403448621 | ||||||||
| Practice Location | |||||||||
| Address1: | 75 MCMILLEN DR | ||||||||
| Address2: | |||||||||
| City: | NEWARK | ||||||||
| State: | OH | ||||||||
| PostalCode: | 430551808 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7403440357 | ||||||||
| FaxNumber: | 7403448621 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/08/2008 | ||||||||
| LastUpdateDate: | 07/16/2008 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | ROTHGERBER | ||||||||
| AuthorizedOfficialFirstName: | ARTHUR | ||||||||
| AuthorizedOfficialMiddleName: | L | ||||||||
| AuthorizedOfficialTitleorPosition: | SR VICE PRESIDENT OF REIMBURSEMENT | ||||||||
| AuthorizedOfficialTelephone: | 5025967300 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | KINDRED HEALTHCARE INC | ||||||||
| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 314000000X | 5482 | OH | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
ID Information
| ID | Type | State | Issuer | Description | 2540254 (FOR OXYGEN) | 05 | OH | MEDICAID |