MEDICARE: KINDRED HOSPITALS EAST, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	282E00000X	Long Term Care Hospital	4457	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	Y31	OTHER	FL	BLUE CROSS

General Provider Information

NPI Number	:	1396820973
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KINDRED HOSPITALS EAST, LLC

Provider Business Mailing Address
First Line	:	PO BOX 530631
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30353-0631
Country	:	US
Telephone Number	:	727-894-8719
Fax Number	:	727-894-0257

Provider Business Practice Location Address
First Line	:	3030 6TH ST S
Second Line	:
City	:	ST PETERSBURG
State	:	FL
Zip	:	33705-3720
Country	:	US
Telephone Number	:	727-894-8719
Fax Number	:	727-894-0257

Authorized Official
Title or Position	:	DIR LICENSURE & CERTIFICATION
Name	:	JOHNETTA TRAYLOR
Credential	:
Telephone Number	:	502-596-6063

Provider Enumeration Date	:	10/25/2006
Last Update Date	:	04/22/2026

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