Healthcare Provider Details

I. General information

NPI: 1427072040
Provider Name (Legal Business Name): KINDRED NURSING CENTERS WEST, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/27/2006
Last Update Date: 09/28/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

76 FENTON ST
LIVERMORE CA
94550-4144
US

IV. Provider business mailing address

680 S. 4TH STREET
LOUISVILLE KY
40202-2407
US

V. Phone/Fax

Practice location:
  • Phone: 925-443-1800
  • Fax: 925-443-6640
Mailing address:
  • Phone: 502-596-7301
  • Fax: 502-596-4134

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number020000040
License Number StateCA

VIII. Authorized Official

Name: MS. MARILYN A. WEAVER
Title or Position: ASSISTANT SECRETARY
Credential:
Phone: 502-596-7563