Basic Information
| Provider Information | |||||||||
| NPI: | 1962580803 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | KINDRED HOSPITALS EAST, LLC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | KINDRED HOSPITAL NEW JERSEY - MORRIS COUNTY | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 400 W BLACKWELL ST | ||||||||
| Address2: | |||||||||
| City: | DOVER | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 078012525 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9735373818 | ||||||||
| FaxNumber: | 9735373895 | ||||||||
| Practice Location | |||||||||
| Address1: | 400 W BLACKWELL ST | ||||||||
| Address2: | |||||||||
| City: | DOVER | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 078012525 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9735373818 | ||||||||
| FaxNumber: | 9735373895 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/01/2006 | ||||||||
| 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 | 282E00000X | 23144 | NJ | Y | Hospitals | Long Term Care Hospital |
ID Information
| ID | Type | State | Issuer | Description | 0054208 | 05 | NJ | MEDICAID | 312020 | 01 | NJ | BLUE CROSS | OTHER |