Provider Demographics
NPI:1538300678
Name:KE HEALTH SERVICES, LLC
Entity Type:Organization
Organization Name:KE HEALTH SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGEING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:A
Authorized Official - Last Name:ENNIS
Authorized Official - Suffix:
Authorized Official - Credentials:APRN, DNPC
Authorized Official - Phone:203-869-2225
Mailing Address - Street 1:30 ORCHARD ST
Mailing Address - Street 2:
Mailing Address - City:COS COB
Mailing Address - State:CT
Mailing Address - Zip Code:06807-2403
Mailing Address - Country:US
Mailing Address - Phone:203-869-2225
Mailing Address - Fax:203-869-4421
Practice Address - Street 1:880 NORTH AVE STE 10
Practice Address - Street 2:
Practice Address - City:BRIDGEPORT
Practice Address - State:CT
Practice Address - Zip Code:06606-5709
Practice Address - Country:US
Practice Address - Phone:203-540-5722
Practice Address - Fax:203-540-5722
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-19
Last Update Date:2009-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health