Provider Demographics
NPI:1659394054
Name:KINDRED NURSING CENTERS EAST, L.L.C.
Entity Type:Organization
Organization Name:KINDRED NURSING CENTERS EAST, L.L.C.
Other - Org Name:
Other - Org Type:
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 1:680 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:592-596-7301
Mailing Address - Fax:502-596-4134
Practice Address - Street 1:75 MCMILLEN DR
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:OH
Practice Address - Zip Code:43055-1808
Practice Address - Country:US
Practice Address - Phone:740-344-0357
Practice Address - Fax:740-344-8621
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:KINDRED HEALTHCARE, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-07-26
Last Update Date:2017-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH5482314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH522085570001OtherAETNA
OH000000157668OtherANTHEM
OH01-03319Medicaid
OH01-03319Medicaid