Healthcare Provider Details

I. General information

NPI: 1932881166
Provider Name (Legal Business Name): KEMET HEALTH ONE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/07/2023
Last Update Date: 11/19/2024
Certification Date: 11/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 N WEST ST STE 1200
WILMINGTON DE
19801-1058
US

IV. Provider business mailing address

169 MADISON AVE # 11841
NEW YORK NY
10016-5101
US

V. Phone/Fax

Practice location:
  • Phone: 703-256-1600
  • Fax:
Mailing address:
  • Phone: 703-256-1600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ANDREW SCHNECK
Title or Position: COO
Credential:
Phone: 703-256-1600