Healthcare Provider Details

I. General information

NPI: 1811554629
Provider Name (Legal Business Name): KINDRED HEALTH, LLC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/28/2019
Last Update Date: 05/28/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6565 FRANCE AVE S STE 350
EDINA MN
55435-2159
US

IV. Provider business mailing address

6565 FRANCE AVE S STE 350
EDINA MN
55435-2159
US

V. Phone/Fax

Practice location:
  • Phone: 952-999-4049
  • Fax:
Mailing address:
  • Phone: 952-999-4049
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: SUZANNE MARY CARLSON-SHIMON
Title or Position: PRESIDENT
Credential: FNP-BC
Phone: 651-491-4354