Provider Demographics
NPI:1790473528
Name:KEKA SERVICES, INC
Entity Type:Organization
Organization Name:KEKA SERVICES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:KENNEDY
Authorized Official - Middle Name:
Authorized Official - Last Name:NDAMBA
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:978-390-6996
Mailing Address - Street 1:1242 RIVER ST
Mailing Address - Street 2:
Mailing Address - City:HYDE PARK
Mailing Address - State:MA
Mailing Address - Zip Code:02136-2833
Mailing Address - Country:US
Mailing Address - Phone:978-390-6996
Mailing Address - Fax:617-272-3952
Practice Address - Street 1:1242 RIVER ST
Practice Address - Street 2:
Practice Address - City:HYDE PARK
Practice Address - State:MA
Practice Address - Zip Code:02136-2833
Practice Address - Country:US
Practice Address - Phone:978-390-6996
Practice Address - Fax:617-272-3952
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-28
Last Update Date:2023-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251G0304XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGeriatricsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1518430651Medicaid