Provider Demographics
NPI:1114213394
Name:KND DEVELOPMENT 59, LLC
Entity Type:Organization
Organization Name:KND DEVELOPMENT 59, LLC
Other - Org Name:4834 KH NORTHLAND
Other - Org Type:Other Name
Authorized Official - Title/Position:SR REG DIR PAT ACCT HD, MID SOUTH D
Authorized Official - Prefix:
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:POCKRUS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:502-596-7358
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:502-596-7300
Mailing Address - Fax:502-596-4150
Practice Address - Street 1:500 NW 68TH ST
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64118-2455
Practice Address - Country:US
Practice Address - Phone:816-420-6300
Practice Address - Fax:502-596-4150
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:KINDRED HEALTHCARE, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-06-25
Last Update Date:2020-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOMA2353OtherMEDICARE
MO1114213394Medicaid