Provider Demographics
NPI:1225120157
Name:KINDRED CARE, LLC
Entity Type:Organization
Organization Name:KINDRED CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR/MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:RAYANNE
Authorized Official - Middle Name:C
Authorized Official - Last Name:STRUBBERG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:573-897-0246
Mailing Address - Street 1:PO BOX 106
Mailing Address - Street 2:
Mailing Address - City:LINN
Mailing Address - State:MO
Mailing Address - Zip Code:65051-0106
Mailing Address - Country:US
Mailing Address - Phone:573-897-0246
Mailing Address - Fax:573-897-0127
Practice Address - Street 1:196 HIGHWAY CC
Practice Address - Street 2:
Practice Address - City:LINN
Practice Address - State:MO
Practice Address - Zip Code:65051-3500
Practice Address - Country:US
Practice Address - Phone:573-897-4548
Practice Address - Fax:573-897-0283
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-28
Last Update Date:2009-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO102497807Medicaid
MO265364Medicare Oscar/Certification