Healthcare Provider Details

I. General information

NPI: 1457100604
Provider Name (Legal Business Name): KEEN IN CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/17/2024
Last Update Date: 05/30/2024
Certification Date: 05/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8301 CLEARWATER CT
SPRING VALLEY CA
91977-6116
US

IV. Provider business mailing address

340 S MONTE VISTA ST APT B
LA HABRA CA
90631-9066
US

V. Phone/Fax

Practice location:
  • Phone: 619-292-2023
  • Fax: 619-872-0649
Mailing address:
  • Phone: 562-805-1741
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code251T00000X
TaxonomyPACE Provider Organization
License Number
License Number StateNULL

VIII. Authorized Official

Name: MR. MARTIN SANTOS
Title or Position: LICENSEE
Credential:
Phone: 562-805-1741