Healthcare Provider Details

I. General information

NPI: 1336598390
Provider Name (Legal Business Name): KINDRED REHAB CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/09/2016
Last Update Date: 07/08/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3320 BENSON AVE
BALTIMORE MD
21227-1035
US

IV. Provider business mailing address

3320 BENSON AVE
BALTIMORE MD
21227
US

V. Phone/Fax

Practice location:
  • Phone: 410-646-6501
  • Fax:
Mailing address:
  • Phone: 410-646-6501
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number24829
License Number StateMD

VIII. Authorized Official

Name: AMANDA POPP
Title or Position: PROGRAM DIRECTOR
Credential:
Phone: 410-591-5808