Provider Demographics
NPI:1578219721
Name:KENAH ONE HEALTH CARE SERVICES, LLC
Entity Type:Organization
Organization Name:KENAH ONE HEALTH CARE SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:KETTY
Authorized Official - Middle Name:M
Authorized Official - Last Name:NGONA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:443-465-9958
Mailing Address - Street 1:308 CRAIN HWY N
Mailing Address - Street 2:
Mailing Address - City:GLEN BURNIE
Mailing Address - State:MD
Mailing Address - Zip Code:21061-3090
Mailing Address - Country:US
Mailing Address - Phone:667-232-1220
Mailing Address - Fax:443-288-4808
Practice Address - Street 1:3719 VEGA RD
Practice Address - Street 2:
Practice Address - City:RANDALLSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21133-3425
Practice Address - Country:US
Practice Address - Phone:667-232-1220
Practice Address - Fax:443-288-4808
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-25
Last Update Date:2022-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness