MEDICARE: KINDRED BH ACQUISITION 3, 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	283Q00000X	Psychiatric Hospital

General Provider Information

NPI Number	:	1811668437
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KINDRED BH ACQUISITION 3, LLC

Provider Business Mailing Address
First Line	:	680 S 4TH ST
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40202-2407
Country	:	US
Telephone Number	:	502-596-7220
Fax Number	:	502-596-4314

Provider Business Practice Location Address
First Line	:	831 LANDON DR
Second Line	:
City	:	BULLHEAD CITY
State	:	AZ
Zip	:	86429-7674
Country	:	US
Telephone Number	:	928-404-6012
Fax Number	:	928-404-2553

Authorized Official
Title or Position	:	ASSISTANT SECRETARY / AO
Name	:	TERRANCE K DILLON
Credential	:
Telephone Number	:	502-596-7220

Provider Enumeration Date	:	09/23/2021
Last Update Date	:	09/23/2021

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