Healthcare Provider Details

I. General information

NPI: 1821770694
Provider Name (Legal Business Name): KEADEE EMERGENCY MINISTRIES INTERVENTION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/02/2023
Last Update Date: 08/02/2023
Certification Date: 08/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13119 FENNWAY RIDGE DR
RIVERVIEW FL
33579-7160
US

IV. Provider business mailing address

13119 FENNWAY RIDGE DR
RIVERVIEW FL
33579-7160
US

V. Phone/Fax

Practice location:
  • Phone: 813-313-6013
  • Fax:
Mailing address:
  • Phone: 813-313-6013
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code253J00000X
TaxonomyFoster Care Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QD1600X
TaxonomyDevelopmental Disabilities Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code261QR0400X
TaxonomyRehabilitation Clinic/Center
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code374K00000X
TaxonomyReligious Nonmedical Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MARGARET OLAJIDE
Title or Position: OWNER
Credential:
Phone: 813-313-6013