Provider Demographics
NPI:1679021042
Name:KETURAH HEALTH, LLC
Entity Type:Organization
Organization Name:KETURAH HEALTH, LLC
Other - Org Name:GREAT COMMUNITY LIVING
Other - Org Type:Other Name
Authorized Official - Title/Position:NURSE PRACITITIONER
Authorized Official - Prefix:
Authorized Official - First Name:KET
Authorized Official - Middle Name:
Authorized Official - Last Name:HARRIS
Authorized Official - Suffix:
Authorized Official - Credentials:DNP
Authorized Official - Phone:469-626-8195
Mailing Address - Street 1:3540 E BROAD ST # 106-264
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:TX
Mailing Address - Zip Code:76063-5633
Mailing Address - Country:US
Mailing Address - Phone:469-626-8195
Mailing Address - Fax:877-705-7282
Practice Address - Street 1:2305 OAK LN STE 103
Practice Address - Street 2:
Practice Address - City:GRAND PRAIRIE
Practice Address - State:TX
Practice Address - Zip Code:75051-8243
Practice Address - Country:US
Practice Address - Phone:469-626-8195
Practice Address - Fax:469-857-8492
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-14
Last Update Date:2024-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP121985207R00000X, 363LF0000X
251B00000X, 261QM0801X, 363LP0808X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)Group - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No251B00000XAgenciesCase ManagementGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty