Healthcare Provider Details

I. General information

NPI: 1417286162
Provider Name (Legal Business Name): KND DEVELOPMENT 59, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/09/2009
Last Update Date: 06/23/2020
Certification Date: 06/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

865 STONE ST
RAHWAY NJ
07065-2742
US

IV. Provider business mailing address

680 S 4TH ST
LOUISVILLE KY
40202-2407
US

V. Phone/Fax

Practice location:
  • Phone: 732-453-2950
  • Fax:
Mailing address:
  • Phone: 502-596-7358
  • Fax: 833-501-9731

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number
License Number State

VIII. Authorized Official

Name: LINDA L FISHER
Title or Position: DVP REVENUE CYCLE
Credential: CPA
Phone: 502-596-7358