Provider Demographics
NPI:1811554629
Name:KINDRED HEALTH, LLC.
Entity Type:Organization
Organization Name:KINDRED HEALTH, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SUZANNE
Authorized Official - Middle Name:MARY
Authorized Official - Last Name:CARLSON-SHIMON
Authorized Official - Suffix:
Authorized Official - Credentials:FNP-BC
Authorized Official - Phone:651-491-4354
Mailing Address - Street 1:6565 FRANCE AVE S STE 350
Mailing Address - Street 2:
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55435-2159
Mailing Address - Country:US
Mailing Address - Phone:952-999-4049
Mailing Address - Fax:
Practice Address - Street 1:6565 FRANCE AVE S STE 350
Practice Address - Street 2:
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55435-2159
Practice Address - Country:US
Practice Address - Phone:952-999-4049
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-28
Last Update Date:2019-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary CareGroup - Single Specialty
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1952731986OtherNPI