Provider Demographics
NPI:1033220348
Name:KINDRED NURSING CENTERS EAST, L.L.C.
Entity Type:Organization
Organization Name:KINDRED NURSING CENTERS EAST, L.L.C.
Other - Org Name:KINDRED NURSING AND REHABILITATION-HENDERSON
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:502-596-7300
Mailing Address - Street 1:680 S. FOURTH ST
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:502-596-6505
Mailing Address - Fax:502-596-4134
Practice Address - Street 1:280 S BECKFORD DR
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NC
Practice Address - Zip Code:27536-2564
Practice Address - Country:US
Practice Address - Phone:252-438-6141
Practice Address - Fax:252-438-6865
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2017-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCNH0307314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0091NOtherBLUE CROSS BLUE SHIELD
NC3415344 & 3426244Medicaid
345344Medicare Oscar/Certification