Provider Demographics
NPI:1083095491
Name:KEYA HEALTH
Entity Type:Organization
Organization Name:KEYA HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:SEBLE
Authorized Official - Middle Name:WONGEL
Authorized Official - Last Name:DEJENE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-261-7001
Mailing Address - Street 1:1801 ROBERT FULTON DR STE 480
Mailing Address - Street 2:
Mailing Address - City:RESTON
Mailing Address - State:VA
Mailing Address - Zip Code:20191-5481
Mailing Address - Country:US
Mailing Address - Phone:703-261-7000
Mailing Address - Fax:708-860-1040
Practice Address - Street 1:1801 ROBERT FULTON DR STE 480
Practice Address - Street 2:
Practice Address - City:RESTON
Practice Address - State:VA
Practice Address - Zip Code:20191-5481
Practice Address - Country:US
Practice Address - Phone:703-261-7000
Practice Address - Fax:708-860-1040
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-11
Last Update Date:2015-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No302R00000XManaged Care OrganizationsHealth Maintenance Organization
No305R00000XManaged Care OrganizationsPreferred Provider Organization