=====================================================
General NPI Number Information
=====================================================
NPI Number | 1811559693
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | KND DEVELOPMENT 59 , LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/02/2019
-----------------------------------------------------
Last Update Date | 07/01/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 815 S VASSAULT ST
-----------------------------------------------------
City | TACOMA
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98465-2008
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 253-444-3320
-----------------------------------------------------
Fax | 502-596-4150
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 34098
-----------------------------------------------------
City | LOUISVILLE
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 40232-4098
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 502-596-7358
-----------------------------------------------------
Fax | 833-501-9731
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DVP REVENUE CYCLE
-----------------------------------------------------
Name | LINDA L FISHER
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 502-596-7358
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 283X00000X
-----------------------------------------------------
Taxonomy Name | Rehabilitation Hospital
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------