Healthcare Provider Details

I. General information

NPI: 1427804319
Provider Name (Legal Business Name): KEYLA KARES CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/30/2024
Last Update Date: 04/30/2024
Certification Date: 04/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

702 MELVILLE AVE
BALTIMORE MD
21218-2553
US

IV. Provider business mailing address

1608 BRIARVIEW CT
SEVERN MD
21144-4410
US

V. Phone/Fax

Practice location:
  • Phone: 301-537-1333
  • Fax:
Mailing address:
  • Phone: 301-537-1333
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code385HR2060X
TaxonomyChild Intellectual and/or Developmental Disabilities Respite Care
License Number
License Number State

VIII. Authorized Official

Name: KEYLA RAGLAND
Title or Position: OWNER/CEO
Credential:
Phone: 301-537-1333