Provider Demographics
NPI:1760707269
Name:KEJ HEALTHCARE INC
Entity Type:Organization
Organization Name:KEJ HEALTHCARE INC
Other - Org Name:BRIGHTSTAR RALEIGH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/VP
Authorized Official - Prefix:MRS
Authorized Official - First Name:KRISTINA
Authorized Official - Middle Name:R
Authorized Official - Last Name:JAVA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-435-1235
Mailing Address - Street 1:3041 BERKS WAY STE 204
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27614-6777
Mailing Address - Country:US
Mailing Address - Phone:919-435-1235
Mailing Address - Fax:919-435-1239
Practice Address - Street 1:3041 BERKS WAY STE 204
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27614-6777
Practice Address - Country:US
Practice Address - Phone:919-435-1235
Practice Address - Fax:919-435-1239
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-29
Last Update Date:2010-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHC4050251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health