Healthcare Provider Details

I. General information

NPI: 1124651351
Provider Name (Legal Business Name): KINDRED HOSPITALS EAST, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/17/2020
Last Update Date: 06/25/2025
Certification Date: 06/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 OAK ST
GREEN COVE SPRINGS FL
32043-4317
US

IV. Provider business mailing address

680 S 4TH ST
LOUISVILLE KY
40202-2407
US

V. Phone/Fax

Practice location:
  • Phone: 904-284-9230
  • Fax: 904-284-6612
Mailing address:
  • Phone: 502-596-6063
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code273Y00000X
TaxonomyRehabilitation Hospital Unit
License Number
License Number State

VIII. Authorized Official

Name: JOHNETTA TRAYLOR
Title or Position: AO
Credential:
Phone: 502-596-6063