Provider Demographics
NPI:1467710814
Name:MEEKEN DIVERSIFIED MANAGEMENT
Entity Type:Organization
Organization Name:MEEKEN DIVERSIFIED MANAGEMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATION OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:HORACE
Authorized Official - Middle Name:WALLACE
Authorized Official - Last Name:KENNER
Authorized Official - Suffix:SR
Authorized Official - Credentials:
Authorized Official - Phone:240-413-2245
Mailing Address - Street 1:6803 EDGEMERE DR
Mailing Address - Street 2:
Mailing Address - City:CAMP SPRINGS
Mailing Address - State:MD
Mailing Address - Zip Code:20748-3939
Mailing Address - Country:US
Mailing Address - Phone:240-413-2245
Mailing Address - Fax:
Practice Address - Street 1:4849 LYDELL RD
Practice Address - Street 2:
Practice Address - City:HYATTSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20781-1116
Practice Address - Country:US
Practice Address - Phone:301-449-2045
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-23
Last Update Date:2012-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility