Provider Demographics
NPI:1114002326
Name:KINDRED NURSING CENTERS LIMITED PARTNERSHIP
Entity Type:Organization
Organization Name:KINDRED NURSING CENTERS LIMITED PARTNERSHIP
Other - Org Name:KINDRED NURSING AND REHABILITATION - NORTHHAVEN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ASSISTANT SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:MARILYN
Authorized Official - Middle Name:
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 1:3300 N BROADWAY ST
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37917-2733
Practice Address - Country:US
Practice Address - Phone:865-689-2052
Practice Address - Fax:865-689-8670
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-26
Last Update Date:2017-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000000148314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN170178OtherBLUE CARE
TN702003626OtherCARITEN
TN44-5297 & 7440384Medicaid
TN702003626OtherCARITEN