=====================================================
General NPI Number Information
=====================================================
NPI Number | 1134204720
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | KINDRED HOSPITALS EAST, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/25/2006
-----------------------------------------------------
Last Update Date | 06/25/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 801 OAK ST
-----------------------------------------------------
City | GREEN COVE SPRINGS
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32043-4317
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 904-284-9230
-----------------------------------------------------
Fax | 904-284-6612
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 680 S 4TH ST
-----------------------------------------------------
City | LOUISVILLE
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 40202-2407
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 502-596-6063
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | AO
-----------------------------------------------------
Name | JOHNETTA TRAYLOR
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 502-596-6063
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 282E00000X
-----------------------------------------------------
Taxonomy Name | Long Term Care Hospital
-----------------------------------------------------
License Number | 4257
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------