Provider Demographics
NPI:1235339300
Name:KEEGAN ENTERPRISES, LLC
Entity Type:Organization
Organization Name:KEEGAN ENTERPRISES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:J
Authorized Official - Last Name:KEEGAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:508-949-6743
Mailing Address - Street 1:PO BOX 1153
Mailing Address - Street 2:
Mailing Address - City:WEBSTER
Mailing Address - State:MA
Mailing Address - Zip Code:01570-4153
Mailing Address - Country:US
Mailing Address - Phone:508-949-6743
Mailing Address - Fax:508-949-6745
Practice Address - Street 1:4 MEADOW LN
Practice Address - Street 2:
Practice Address - City:DUDLEY
Practice Address - State:MA
Practice Address - Zip Code:01571-3723
Practice Address - Country:US
Practice Address - Phone:508-949-6743
Practice Address - Fax:508-949-6745
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-18
Last Update Date:2007-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1720058Medicaid
MA1540327Medicaid