Provider Demographics
NPI:1033127113
Name:KINDRED NURSING CENTERS WEST, LLC
Entity Type:Organization
Organization Name:KINDRED NURSING CENTERS WEST, LLC
Other - Org Name:KINDRED NURSING AND REHABILITATION - PARKVIEW
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ASSISTANT SECRETARY
Authorized Official - Prefix:MS
Authorized Official - First Name:MARILYN
Authorized Official - Middle Name:A
Authorized Official - Last Name:WEAVER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:502-596-7563
Mailing Address - Street 1:680 S 4TH ST # KH-2
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40202-2407
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:200 N OREGON ST
Practice Address - Street 2:
Practice Address - City:DILLON
Practice Address - State:MT
Practice Address - Zip Code:59725-3624
Practice Address - Country:US
Practice Address - Phone:406-683-5105
Practice Address - Fax:406-683-6388
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-04
Last Update Date:2017-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT9914314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO60928OtherBLUE CROSS/BLUE SHIELD PT
MT41492OtherBLUE CROSS/BLUE SHIELD
MT31-0471Medicaid
MT661200OtherBLUE CROSS/BLUE SHIELD OT
MT661190OtherBLUE CROSS/BLUE SHIELD ST
275124Medicare Oscar/Certification