Healthcare Provider Details

I. General information

NPI: 1215247978
Provider Name (Legal Business Name): KND DEVELOPMENT 53, L.L.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/15/2010
Last Update Date: 03/11/2024
Certification Date: 03/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1246 W. 155TH ST
GARDENA CA
90247-4011
US

IV. Provider business mailing address

680 S 4TH ST K-LIVE 5 REIMBURSEMENT
LOUISVILLE KY
40202-2407
US

V. Phone/Fax

Practice location:
  • Phone: 310-323-5330
  • Fax:
Mailing address:
  • Phone: 502-596-7300
  • Fax: 502-596-4134

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282E00000X
TaxonomyLong Term Care Hospital
License Number
License Number State

VIII. Authorized Official

Name: KATHY TEAGUE
Title or Position: VICE PRESIDENT, CORPORATE SECRETARY
Credential:
Phone: 629-253-5121