Provider Demographics
NPI:1790501203
Name:KINDRED CENTER FOR INDEPENDENCE L.C.
Entity type:Organization
Organization Name:KINDRED CENTER FOR INDEPENDENCE L.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:GILDAS
Authorized Official - Middle Name:
Authorized Official - Last Name:AGBASSOU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:531-600-3934
Mailing Address - Street 1:1201 GOLDEN GATE DR
Mailing Address - Street 2:
Mailing Address - City:PAPILLION
Mailing Address - State:NE
Mailing Address - Zip Code:68046-2837
Mailing Address - Country:US
Mailing Address - Phone:531-600-3934
Mailing Address - Fax:
Practice Address - Street 1:1201 GOLDEN GATE DR
Practice Address - Street 2:
Practice Address - City:PAPILLION
Practice Address - State:NE
Practice Address - Zip Code:68046-2837
Practice Address - Country:US
Practice Address - Phone:531-600-3934
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-29
Last Update Date:2025-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
No251S00000XAgenciesCommunity/Behavioral Health
No253Z00000XAgenciesIn Home Supportive Care
No315P00000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Intellectual Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE95915990Medicaid