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General NPI Number Information
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NPI Number | 1538300678
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Entity Type | Organization
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Legal Business Name | KE HEALTH SERVICES, LLC
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Dates
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Enumeration Date | 03/19/2009
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Last Update Date | 03/19/2009
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Provider Practice Location Address
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Address Line | 880 NORTH AVE STE 10
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City | BRIDGEPORT
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State | CT
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Zip | 06606-5709
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Country | US
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Telephone | 203-540-5722
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Fax | 203-540-5722
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Provider Business Mailing Address
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Address Line | 30 ORCHARD ST
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City | COS COB
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State | CT
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Zip | 06807-2403
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Country | US
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Telephone | 203-869-2225
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Fax | 203-869-4421
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Authorized Official
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Title or Position | MANAGEING MEMBER
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Name | KATHLEEN A ENNIS
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Credential | APRN, DNPC
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Telephone | 203-869-2225
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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