Keda,LLC

Primary specialty

Intellectual and/or Developmental Disabilities Community Based Residential Treatment FacilityTaxonomy code 320900000X

License

3205 Issued in VA

Legal business name

KEDA,LLC

Practice address

143 Maple Rd
Mathews, VA 23109-2139

Phone

(804) 725-8624

NPI assigned

Jun 22, 2018

Last updated

Jun 22, 2018By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Stacy Hardcastle

Title

Owner

Phone

(804) 725-8624

Specialties & licenses 1

Addresses

Other identifiers 1

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1529625600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1529625600000",
    "number": "1255825287",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "38 LITTLE ST",
            "city": "DUTTON",
            "state": "VA",
            "postal_code": "230509732",
            "telephone_number": "804-725-8624"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "143 MAPLE RD",
            "city": "MATHEWS",
            "state": "VA",
            "postal_code": "231092139",
            "telephone_number": "804-725-8624"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KEDA,LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-06-22",
        "last_updated": "2018-06-22",
        "status": "A",
        "authorized_official_last_name": "HARDCASTLE",
        "authorized_official_first_name": "STACY",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "804-725-8624"
    },
    "taxonomies": [
        {
            "code": "320900000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": "VA",
            "license": "3205",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DBHDS LIC.#",
            "identifier": "3205",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Courtney Henry, PMHNP
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• Leah Hurst, FNP-C
• Joyful Journeys Transportation LLC
• Lynette R Glockner, Inc. (Mathews Pharmacy)
• Mathews County Public Schools
• Robert A May, R.PH
• Middle Peninsula Medical Center Inc
• Kathryn Charles Miles, PMHNP-BC

• Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility in Mathews, VA
• Providers in Mathews, VA by specialty
• Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 22, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.