MEDICARE: GEORGE KEENAN

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	372600000X	Adult Companion		CA

General Provider Information

NPI Number	:	1609291517
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GEORGE KEENAN

Provider Business Mailing Address
First Line	:	1695 SUNSET AVE
Second Line	:
City	:	FAIRFIELD
State	:	CA
Zip	:	94533-4255
Country	:	US
Telephone Number	:	707-648-8121
Fax Number	:	707-648-8129

Provider Business Practice Location Address
First Line	:	1695 SUNSET AVE
Second Line	:
City	:	FAIRFIELD
State	:	CA
Zip	:	94533-4255
Country	:	US
Telephone Number	:	707-557-8975
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/28/2014
Last Update Date	:	06/11/2026

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