=====================================================
General NPI Number Information
=====================================================
NPI Number | 1174544258
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | KINDRED NURSING CENTERS LIMITED PARTNERSHIP
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/22/2006
-----------------------------------------------------
Last Update Date | 09/18/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1012 JAMESTOWN WAY
-----------------------------------------------------
City | MARYVILLE
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37803-5865
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 865-984-7400
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 680 S. FOURTH ST
-----------------------------------------------------
City | LOUISVILLE
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 40202-2407
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 502-596-6505
-----------------------------------------------------
Fax | 502-596-4134
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ASSISTANT SECRETARY
-----------------------------------------------------
Name | MARILYN WEAVER
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 502-596-7300
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 314000000X
-----------------------------------------------------
Taxonomy Name | Skilled Nursing Facility
-----------------------------------------------------
License Number | 0000000013
-----------------------------------------------------
License Number State | TN
-----------------------------------------------------