Basic Information
| Provider Information | |||||||||
| NPI: | 1811668437 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | KINDRED BH ACQUISITION 3, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 680 S 4TH ST | ||||||||
| Address2: | |||||||||
| City: | LOUISVILLE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 402022407 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5025967220 | ||||||||
| FaxNumber: | 5025964314 | ||||||||
| Practice Location | |||||||||
| Address1: | 831 LANDON DR | ||||||||
| Address2: | |||||||||
| City: | BULLHEAD CITY | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 864297674 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9284046012 | ||||||||
| FaxNumber: | 9284042553 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/23/2021 | ||||||||
| LastUpdateDate: | 09/23/2021 | ||||||||
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| AuthorizedOfficialLastName: | DILLON | ||||||||
| AuthorizedOfficialFirstName: | TERRANCE | ||||||||
| AuthorizedOfficialMiddleName: | K | ||||||||
| AuthorizedOfficialTitleorPosition: | ASSISTANT SECRETARY / AO | ||||||||
| AuthorizedOfficialTelephone: | 5025967220 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 09/23/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 283Q00000X | Y | Hospitals | Psychiatric Hospital |
No ID Information.