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General NPI Number Information
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NPI Number | 1649641580
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Entity Type | Organization
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Legal Business Name | KINDRED HEALTH CARE
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Dates
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Enumeration Date | 10/19/2015
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Last Update Date | 10/19/2015
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Provider Practice Location Address
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Address Line | 1251 COLLEGE AVE
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City | ALTON
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State | IL
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Zip | 62002-6735
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Country | US
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Telephone | 618-463-7849
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Fax |
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Provider Business Mailing Address
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Address Line | 1251 COLLEGE AVENUE
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City | ALTON
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State | IL
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Zip | 62002
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OCCUPATIONAL THERAPIST
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Name | KILEY HAVERA
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Credential |
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Telephone | 217-710-0482
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number | 056011139
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License Number State | IL
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