Healthcare Provider Details

I. General information

NPI: 1760707269
Provider Name (Legal Business Name): KEJ HEALTHCARE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/29/2010
Last Update Date: 03/29/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3041 BERKS WAY STE 204
RALEIGH NC
27614-6777
US

IV. Provider business mailing address

3041 BERKS WAY STE 204
RALEIGH NC
27614-6777
US

V. Phone/Fax

Practice location:
  • Phone: 919-435-1235
  • Fax: 919-435-1239
Mailing address:
  • Phone: 919-435-1235
  • Fax: 919-435-1239

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License NumberHC4050
License Number StateNC

VIII. Authorized Official

Name: MRS. KRISTINA R JAVA
Title or Position: OWNER/VP
Credential:
Phone: 919-435-1235