Healthcare Provider Details

I. General information

NPI: 1366465742
Provider Name (Legal Business Name): KINDRED NURSING CENTERS WEST, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/26/2006
Last Update Date: 10/18/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

420 ROWE ST
MOSCOW ID
83843-9319
US

IV. Provider business mailing address

680 S 4TH ST
LOUISVILLE KY
40202-2407
US

V. Phone/Fax

Practice location:
  • Phone: 208-882-4576
  • Fax: 208-882-1542
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 Number7
License Number StateID

VIII. Authorized Official

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