Provider Demographics
NPI:1497983936
Name:KINDRED DEVELOPMENT 17, LLC
Entity Type:Organization
Organization Name:KINDRED DEVELOPMENT 17, LLC
Other - Org Name:KINDRED HOSPITAL MELBOURNE
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 1:765 W NASA BLVD
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32901-1815
Mailing Address - Country:US
Mailing Address - Phone:321-733-5725
Mailing Address - Fax:321-733-5799
Practice Address - Street 1:765 W NASA BLVD
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32901-1815
Practice Address - Country:US
Practice Address - Phone:321-733-5725
Practice Address - Fax:321-733-5725
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-23
Last Update Date:2024-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL4501282E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282E00000XHospitalsLong Term Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL102027Medicare Oscar/Certification