Healthcare Provider Details

I. General information

NPI: 1528184595
Provider Name (Legal Business Name): BRENDA S. KEENE CFH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/22/2007
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1227 W EMMY CT
KUNA ID
83634-3028
US

IV. Provider business mailing address

1227 W EMMY CT
KUNA ID
83634-3028
US

V. Phone/Fax

Practice location:
  • Phone: 208-922-3000
  • Fax: 208-922-3384
Mailing address:
  • Phone: 208-922-3000
  • Fax: 208-922-3384

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License Number40434
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: