Healthcare Provider Details

I. General information

NPI: 1215910211
Provider Name (Legal Business Name): KINDER RETIREMENT AND REHABILITATION CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/22/2005
Last Update Date: 01/07/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13938 HWY 165
KINDER LA
70648
US

IV. Provider business mailing address

PO BOX 1270
KINDER LA
70648-1270
US

V. Phone/Fax

Practice location:
  • Phone: 337-738-5671
  • Fax: 337-738-5777
Mailing address:
  • Phone: 337-738-5671
  • Fax: 337-738-5777

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number360
License Number StateLA

VIII. Authorized Official

Name: MR. JACK SANDERS
Title or Position: MANAGING MEMBER
Credential:
Phone: 318-590-0007