Provider Demographics
NPI:1780204586
Name:KEEP WELL NOW
Entity Type:Organization
Organization Name:KEEP WELL NOW
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:TERESA
Authorized Official - Middle Name:
Authorized Official - Last Name:JENNEWEIN
Authorized Official - Suffix:
Authorized Official - Credentials:MHA
Authorized Official - Phone:417-983-6497
Mailing Address - Street 1:2405 ASPEN RD
Mailing Address - Street 2:
Mailing Address - City:HIGHLANDVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:65669-8051
Mailing Address - Country:US
Mailing Address - Phone:417-983-6497
Mailing Address - Fax:
Practice Address - Street 1:2405 ASPEN RD
Practice Address - Street 2:
Practice Address - City:HIGHLANDVILLE
Practice Address - State:MO
Practice Address - Zip Code:65669-8051
Practice Address - Country:US
Practice Address - Phone:417-983-6497
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-21
Last Update Date:2020-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center