Provider Demographics
NPI:1538102215
Name:KINDRED REHAB SERVICES INC
Entity Type:Organization
Organization Name:KINDRED REHAB SERVICES INC
Other - Org Name:BEDFORD OUTPATIENT THERAPY SPECIALISTS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ASSISTANT SECRETARY
Authorized Official - Prefix:MS
Authorized Official - First Name:MARILYN
Authorized Official - Middle Name:A
Authorized Official - Last Name:WEAVER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:502-596-7300
Mailing Address - Street 1:2137 16TH ST
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:IN
Mailing Address - Zip Code:47421-3003
Mailing Address - Country:US
Mailing Address - Phone:812-275-5593
Mailing Address - Fax:812-275-5598
Practice Address - Street 1:2137 16TH ST
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:IN
Practice Address - Zip Code:47421-3003
Practice Address - Country:US
Practice Address - Phone:812-275-5593
Practice Address - Fax:812-275-5598
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-13
Last Update Date:2015-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR0401XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF)
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
000000373957OtherANTHEM BILL ALLEN PT
12418OtherSIHO
IN200731960Medicaid
000000330128OtherANTHEM DEBBY TOTH OT
000000373802OtherANTHEM MELINDA WELSCH OT
IN200660710Medicaid
000000373957OtherANTHEM BILL ALLEN PT
=========OtherFEDERAL TAX ID
12418OtherSIHO
IN200660710Medicaid
IN200731960Medicaid