Healthcare Provider Details

I. General information

NPI: 1841886959
Provider Name (Legal Business Name): KINDRED DEVELOPMENT 17, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/14/2020
Last Update Date: 03/11/2024
Certification Date: 03/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

765 W NASA BLVD
MELBOURNE FL
32901-1815
US

IV. Provider business mailing address

765 W NASA BLVD
MELBOURNE FL
32901-1815
US

V. Phone/Fax

Practice location:
  • Phone: 321-733-5725
  • Fax: 321-733-5799
Mailing address:
  • Phone: 321-733-5725
  • Fax: 321-733-5799

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