Provider Demographics
NPI:1790329530
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:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KULVINDER
Authorized Official - Middle Name:SINGH
Authorized Official - Last Name:BASRA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:240-949-4886
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:443-354-3989
Mailing Address - Fax:443-288-4808
Practice Address - Street 1:308 CRAIN HWY N
Practice Address - Street 2:
Practice Address - City:GLEN BURNIE
Practice Address - State:MD
Practice Address - Zip Code:21061-3090
Practice Address - Country:US
Practice Address - Phone:443-354-3989
Practice Address - Fax:443-288-4808
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-05
Last Update Date:2020-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty
No103TR0400XBehavioral Health & Social Service ProvidersPsychologistRehabilitationGroup - Single Specialty
No251S00000XAgenciesCommunity/Behavioral Health
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)Group - Multi-Specialty