Provider Demographics
NPI:1851405294
Name:KELLERS NURSING HOME INC
Entity Type:Organization
Organization Name:KELLERS NURSING HOME INC
Other - Org Name:KELLERS OAKHAVEN RETIREMENT HOME
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:KELLER
Authorized Official - Last Name:KELLY
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:919-775-1853
Mailing Address - Street 1:PO BOX 640
Mailing Address - Street 2:
Mailing Address - City:SANFORD
Mailing Address - State:NC
Mailing Address - Zip Code:27331-0640
Mailing Address - Country:US
Mailing Address - Phone:919-775-1853
Mailing Address - Fax:919-774-6482
Practice Address - Street 1:700 WESTOVER DR
Practice Address - Street 2:
Practice Address - City:SANFORD
Practice Address - State:NC
Practice Address - Zip Code:27331-0640
Practice Address - Country:US
Practice Address - Phone:919-775-1853
Practice Address - Fax:919-774-6482
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHAL-053-001311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7802023Medicaid