Provider Demographics
NPI:1467230557
Name:KENA RAE LLC
Entity Type:Organization
Organization Name:KENA RAE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:
Authorized Official - Last Name:BASTONE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:302-765-7802
Mailing Address - Street 1:7310 RITCHIE HWY STE 200 #1018
Mailing Address - Street 2:
Mailing Address - City:GLEN BURNIE
Mailing Address - State:MD
Mailing Address - Zip Code:21061
Mailing Address - Country:US
Mailing Address - Phone:800-546-1107
Mailing Address - Fax:
Practice Address - Street 1:7310 RITCHIE HWY STE 200 #1018
Practice Address - Street 2:
Practice Address - City:GLEN BURNIE
Practice Address - State:MD
Practice Address - Zip Code:21061
Practice Address - Country:US
Practice Address - Phone:800-546-1107
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-19
Last Update Date:2023-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization
No251K00000XAgenciesPublic Health or Welfare