Provider Demographics
NPI:1083637011
Name:KINDRED NURSING CENTERS WEST, LLC
Entity Type:Organization
Organization Name:KINDRED NURSING CENTERS WEST, LLC
Other - Org Name:
Other - Org Type:
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
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:502-596-7301
Mailing Address - Fax:502-596-4134
Practice Address - Street 1:3315 8TH ST
Practice Address - Street 2:
Practice Address - City:LEWISTON
Practice Address - State:ID
Practice Address - Zip Code:83501-4966
Practice Address - Country:US
Practice Address - Phone:208-743-9543
Practice Address - Fax:208-743-3945
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-25
Last Update Date:2017-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID22314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID805218400Medicaid
ID01214OtherBLUE CROSS OF IDAHO
ID337239337239OtherPREMERA BLUE CROSS
ID000010013498OtherREGENCE BLUE SHIELD
ID000010013498OtherREGENCE BLUE SHIELD