MEDICARE: KEJ HEALTHCARE INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251E00000X	Home Health Agency	HC4050	NC

General Provider Information

NPI Number	:	1760707269
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KEJ HEALTHCARE INC

Provider Business Mailing Address
First Line	:	3041 BERKS WAY STE 204
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27614-6777
Country	:	US
Telephone Number	:	919-435-1235
Fax Number	:	919-435-1239

Provider Business Practice Location Address
First Line	:	3041 BERKS WAY STE 204
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27614-6777
Country	:	US
Telephone Number	:	919-435-1235
Fax Number	:	919-435-1239

Authorized Official
Title or Position	:	OWNER/VP
Name	:	MRS. KRISTINA R JAVA
Credential	:
Telephone Number	:	919-435-1235

Provider Enumeration Date	:	03/29/2010
Last Update Date	:	03/29/2010

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