Klondike Manor, LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

100424 Issued in KY

Legal business name

KLONDIKE MANOR, LLC

Practice address

3802 Klondike Lane
Louisville, KY 40218-1796

Phone

(502) 452-1579

Fax

(502) 451-9310

NPI assigned

Aug 17, 2006

Organization subpart

Yes

Parent organization

SUNBRIDGE HEALTHCARE CORPORATIONAs reported in NPPES

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

William Mathies

Title

President Director

Phone

(505) 821-3355

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Klondike Care and Rehabilitation Center Doing business as

Part of

Terrace Hghts Nursing H

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

• Sunbridge Healthcare LLC

  • Skilled Nursing Facility
  • Tuscumbia, AL
  • NPI 1285685362

  Member Of

  NPD member

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1155772800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1254355200000",
    "number": "1801909304",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "101 SUN AVE NE",
            "address_2": "COMPLIANCE DEPARTMENT",
            "city": "ALBUQUERQUE",
            "state": "NM",
            "postal_code": "871094373",
            "telephone_number": "505-468-5604",
            "fax_number": "505-468-4681"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3802 KLONDIKE LANE",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402181796",
            "telephone_number": "502-452-1579",
            "fax_number": "502-451-9310"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KLONDIKE MANOR, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "SUNBRIDGE HEALTHCARE CORPORATION",
        "enumeration_date": "2006-08-17",
        "last_updated": "2009-10-01",
        "status": "A",
        "authorized_official_last_name": "MATHIES",
        "authorized_official_first_name": "WILLIAM",
        "authorized_official_title_or_position": "PRESIDENT DIRECTOR",
        "authorized_official_telephone_number": "505-821-3355"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "KY",
            "license": "100424",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "12504833",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Klondike Care and Rehabilitation Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Darilynne J Klockmann, CRNA
• Goetz Kloecker, MD
• Jennifer K Kloft, AUD
• Klondike Chiropractic Medical Center LLC
• Klondike Health Center LLC
• Mary Angelique Klondike
• Jerry Klopfenstein, LCSW
• Kelly Klump
• Stephen Klump, LPCC
• Kimberly Klutey

• Skilled Nursing Facility in Louisville, KY
• Providers in Louisville, KY by specialty
• Skilled Nursing Facility in Kentucky

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 1, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.