Healthcare Provider Details

I. General information

NPI: 1811559693
Provider Name (Legal Business Name): KND DEVELOPMENT 59 , LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/02/2019
Last Update Date: 07/01/2020
Certification Date: 07/01/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

815 S VASSAULT ST
TACOMA WA
98465-2008
US

IV. Provider business mailing address

PO BOX 34098
LOUISVILLE KY
40232-4098
US

V. Phone/Fax

Practice location:
  • Phone: 253-444-3320
  • Fax: 502-596-4150
Mailing address:
  • Phone: 502-596-7358
  • Fax: 833-501-9731

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code283X00000X
TaxonomyRehabilitation Hospital
License Number
License Number State

VIII. Authorized Official

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