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NPI Code Detail

MEDICARE: KINDRED DEVELOPMENT 17, LLC

MEDICARE: KINDRED DEVELOPMENT 17, LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1273Y00000XRehabilitation Hospital Unit

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
14501OTHERFLHOSPITAL LICENSE

General Provider Information

NPI Number : 1841886959
Entity Type Code : Organization
Provider Name (Legal Business Name) : KINDRED DEVELOPMENT 17, LLC
Provider Business Mailing Address
First Line : 765 W NASA BLVD
Second Line :
City : MELBOURNE
State : FL
Zip : 32901-1815
Country : US
Telephone Number : 321-733-5725
Fax Number : 321-733-5799
Provider Business Practice Location Address
First Line : 765 W NASA BLVD
Second Line :
City : MELBOURNE
State : FL
Zip : 32901-1815
Country : US
Telephone Number : 321-733-5725
Fax Number : 321-733-5799
Authorized Official
Title or Position : VICE PRESIDENT, CORPORATE SECRETARY
Name : KATHY TEAGUE
Credential :
Telephone Number : 629-253-5121
Provider Enumeration Date : 12/14/2020
Last Update Date : 03/11/2024

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Directions to “KINDRED DEVELOPMENT 17, LLC ” Practice Location

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