Provider Demographics
NPI:1427387919
Name:KND DEVELOPMENT 59 , LLC
Entity Type:Organization
Organization Name:KND DEVELOPMENT 59 , LLC
Other - Org Name:4680 KH ST LOUIS
Other - Org Type:Other Name
Authorized Official - Title/Position:DVP REVENUE CYCLE
Authorized Official - Prefix:
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:L
Authorized Official - Last Name:FISHER
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:502-596-7358
Mailing Address - Fax:833-501-9731
Practice Address - Street 1:4930 LINDELL BLVD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63108-1510
Practice Address - Country:US
Practice Address - Phone:314-361-8700
Practice Address - Fax:502-596-4150
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:KINDRED HEALTHCARE, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-12-14
Last Update Date:2020-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1427387919Medicaid
MOMA3115OtherMEDICARE