Provider Demographics
NPI:1376621235
Name:KINDRED HOSPITALS EAST, LLC
Entity Type:Organization
Organization Name:KINDRED HOSPITALS EAST, LLC
Other - Org Name:KINDRED HOSPITAL - EAST NEW JERSEY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT, CORPORATE SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:KATHY
Authorized Official - Middle Name:
Authorized Official - Last Name:TEAGUE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:629-253-5121
Mailing Address - Street 1:350 BOULEVARD FL 5
Mailing Address - Street 2:
Mailing Address - City:PASSAIC
Mailing Address - State:NJ
Mailing Address - Zip Code:07055-2840
Mailing Address - Country:US
Mailing Address - Phone:973-636-7200
Mailing Address - Fax:973-595-6432
Practice Address - Street 1:350 BOULEVARD FL 5
Practice Address - Street 2:
Practice Address - City:PASSAIC
Practice Address - State:NJ
Practice Address - Zip Code:07055-2840
Practice Address - Country:US
Practice Address - Phone:973-636-7200
Practice Address - Fax:973-595-6432
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2024-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ24048282E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282E00000XHospitalsLong Term Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0054208Medicaid
NJ312020-00OtherBLUE CROSS
NJ=========OtherAETNA
NJ=========OtherAETNA