Kindred Nursing Centers West, LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

LTC55307I Issued in CA

Legal business name

KINDRED NURSING CENTERS WEST, LLC

Practice address

1517 E Knickerbocker Dr
Stockton, CA 95210-3119

Phone

(209) 957-4539

Fax

(209) 957-5831

NPI assigned

Jul 30, 2006

Organization subpart

No

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

Authorized official

Name

Ms. Marilyn A. Weaver

Title

Assistant Secretary

Phone

(502) 596-7563

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Kindred Transitional Care and Rehabilitation - Valley Gardens Doing business as

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

{
    "created_epoch": "1154217600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1506556800000",
    "number": "1891700464",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "680 S. 4TH STREET",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402022407",
            "telephone_number": "502-596-7301",
            "fax_number": "502-596-4134"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1517 E KNICKERBOCKER DR",
            "city": "STOCKTON",
            "state": "CA",
            "postal_code": "952103119",
            "telephone_number": "209-957-4539",
            "fax_number": "209-957-5831"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KINDRED NURSING CENTERS WEST, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-30",
        "last_updated": "2017-09-28",
        "status": "A",
        "authorized_official_last_name": "WEAVER",
        "authorized_official_first_name": "MARILYN",
        "authorized_official_middle_name": "A.",
        "authorized_official_title_or_position": "ASSISTANT SECRETARY",
        "authorized_official_telephone_number": "502-596-7563",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "CA",
            "license": "LTC55307I",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "LTC55307I",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Kindred Transitional Care and Rehabilitation - Valley Gardens",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Kimberly Burton, Inc.
• Latonya Kimbrough
• Kylie Kimes
• Camille Kimmerly
• Ana Kimwell
• Amanda Lyn King, LMFT
• Courtney Taylor King
• Donna Rae King, RPH
• Jyriaynna King
• Maurice Santell King

• Skilled Nursing Facility in Stockton, CA
• Providers in Stockton, CA by specialty
• Skilled Nursing Facility in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 28, 2017; 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.