Provider Demographics
NPI:1396820973
Name:KINDRED HOSPITALS EAST, LLC
Entity Type:Organization
Organization Name:KINDRED HOSPITALS EAST, LLC
Other - Org Name:KINDRED HOSPITAL - BAY AREA - ST. PETERSBURG
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 1:3030 6TH ST S
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33705-3720
Mailing Address - Country:US
Mailing Address - Phone:727-894-8719
Mailing Address - Fax:727-894-0257
Practice Address - Street 1:3030 6TH ST S
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33705-3720
Practice Address - Country:US
Practice Address - Phone:727-894-8719
Practice Address - Fax:727-894-0257
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-25
Last Update Date:2024-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL4457282E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282E00000XHospitalsLong Term Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL010276800Medicaid
FLY31OtherBLUE CROSS
FL=========OtherCIGNA
FL=========OtherUNITED HEALTHCARE
FL010276800Medicaid
FLY31OtherBLUE CROSS
FL=========OtherHUMANA