Provider Demographics
NPI:1386973105
Name:KND DEVELOPMENT 59, LLC
Entity type:Organization
Organization Name:KND DEVELOPMENT 59, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SRVP & CFO
Authorized Official - Prefix:
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:L
Authorized Official - Last Name:FISHER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:502-596-7358
Mailing Address - Street 1:680 S 4TH ST
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40202-2407
Mailing Address - Country:US
Mailing Address - Phone:502-596-7358
Mailing Address - Fax:833-501-9731
Practice Address - Street 1:10018 KENNERLY RD
Practice Address - Street 2:3RD FLOOR, HYLAND BUILDING B, ST.
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63128-2106
Practice Address - Country:US
Practice Address - Phone:314-525-8100
Practice Address - Fax:502-596-4150
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:KINDRED HEALTHCARE, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-12-08
Last Update Date:2021-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOMA3115OtherMEDICARE