Provider Demographics
NPI: | 1235811951 |
---|---|
Name: | KEMET HEALTH ONE LLC |
Entity Type: | Organization |
Organization Name: | KEMET HEALTH ONE LLC |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | COO |
Authorized Official - Prefix: | |
Authorized Official - First Name: | ANDREW |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | SCHNECK |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 703-256-1600 |
Mailing Address - Street 1: | 5413A BACKLICK RD |
Mailing Address - Street 2: | |
Mailing Address - City: | SPRINGFIELD |
Mailing Address - State: | VA |
Mailing Address - Zip Code: | 22151-3915 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 703-256-1600 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 317 E CAPITOL ST STE 200 |
Practice Address - Street 2: | |
Practice Address - City: | JACKSON |
Practice Address - State: | MS |
Practice Address - Zip Code: | 39201-3405 |
Practice Address - Country: | US |
Practice Address - Phone: | 703-256-1600 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | Yes |
Parent Organization LBN: | KEMET HEALTH ONE LLC |
Parent Organization TIN: | <UNAVAIL> |
Enumeration Date: | 2023-08-02 |
Last Update Date: | 2023-08-02 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 261QM1300X | Ambulatory Health Care Facilities | Clinic/Center | Multi-Specialty |
No | 261QM0850X | Ambulatory Health Care Facilities | Clinic/Center | Adult Mental Health |