Keellen, LLC

Primary specialty

Emotionally Disturbed Childrens' Residential Treatment FacilityTaxonomy code 322D00000X

License

MHL-030-028 Issued in NC

Legal business name

KEELLEN, LLC

Practice address

313 Park Ave
Creedmoor, NC 27522-0313

Phone

(919) 529-1965

Fax

(919) 764-9731

NPI assigned

Oct 25, 2006

Organization subpart

No

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

Authorized official

Name

Mrs. Mary Ellen Johnson

Title

Owner

Phone

(919) 529-1965

Specialties & licenses 1

Addresses

Other identifiers 1

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

{
    "created_epoch": "1161734400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1238630400000",
    "number": "1740365220",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 14",
            "city": "CREEDMOOR",
            "state": "NC",
            "postal_code": "275220014",
            "telephone_number": "919-529-1965",
            "fax_number": "919-764-9731"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "313 PARK AVE",
            "city": "CREEDMOOR",
            "state": "NC",
            "postal_code": "275220313",
            "telephone_number": "919-529-1965",
            "fax_number": "919-764-9731"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KEELLEN, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-25",
        "last_updated": "2009-04-02",
        "status": "A",
        "authorized_official_last_name": "JOHNSON",
        "authorized_official_first_name": "MARY",
        "authorized_official_middle_name": "ELLEN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "919-529-1965",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "322D00000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Emotionally Disturbed Children",
            "state": "NC",
            "license": "MHL-030-028",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6603254",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jolene Jean-Gracia, DO
• James Brian Jessee
• Shanta Johnson, LCSW
• Patricia Dillard Jones, M.A., LPC, LCAS, CCS
• Anand S Katta, RPH
• Kenneth R Marsh DDS PA
• Babita Khera
• Koren & Associates, DDS, PA
• Alyssa Krueger, DO
• Kyle J Roth IV DDS PA

• Emotionally Disturbed Childrens' Residential Treatment Facility in Creedmoor, NC
• Providers in Creedmoor, NC by specialty
• Emotionally Disturbed Childrens' Residential Treatment Facility in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 2, 2009; 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.