Healthcare Provider Details

I. General information

NPI: 1134230899
Provider Name (Legal Business Name): KINDRED NURSING CENTERS WEST, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 09/15/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 HARRIS RD
NASHUA NH
03062-2145
US

IV. Provider business mailing address

680 S. FOURTH STREET
LOUISVILLE KY
40202-2407
US

V. Phone/Fax

Practice location:
  • Phone: 603-888-1573
  • Fax: 603-888-5089
Mailing address:
  • Phone: 502-596-6505
  • Fax: 502-596-4134

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number02603
License Number StateNH

VIII. Authorized Official

Name: MARILYN WEAVER
Title or Position: ASSISTANT SECRETARY
Credential:
Phone: 502-596-7300