Healthcare Provider Details

I. General information

NPI: 1457514622
Provider Name (Legal Business Name): KINDRED NURSING CENTERS EAST LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/08/2008
Last Update Date: 08/04/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 ARLINGTON AVE
LOGAN OH
43138-1708
US

IV. Provider business mailing address

300 ARLINGTON AVE
LOGAN OH
43138-1708
US

V. Phone/Fax

Practice location:
  • Phone: 740-385-2155
  • Fax: 740-385-1789
Mailing address:
  • Phone: 740-385-2155
  • Fax: 740-385-1789

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number1687
License Number StateOH

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier2540307 (FOR OXYGEN)
Identifier TypeMEDICAID
Identifier StateOH
Identifier Issuer

VIII. Authorized Official

Name: MR. ARTHUR L ROTHGERBER
Title or Position: SR VICE PRESIDENT OF REIMBURSEMENT
Credential:
Phone: 502-596-7300