Provider Demographics
NPI:1992018881
Name:KEOUGH SENIOR LIVING LLC
Entity Type:Organization
Organization Name:KEOUGH SENIOR LIVING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:FRANCIS
Authorized Official - Middle Name:PATRICK
Authorized Official - Last Name:KEOUGH
Authorized Official - Suffix:II
Authorized Official - Credentials:RMA
Authorized Official - Phone:703-579-9972
Mailing Address - Street 1:4308 LEES CORNER RD
Mailing Address - Street 2:
Mailing Address - City:CHANTILLY
Mailing Address - State:VA
Mailing Address - Zip Code:20151-2824
Mailing Address - Country:US
Mailing Address - Phone:703-579-9972
Mailing Address - Fax:703-817-1574
Practice Address - Street 1:4308 LEES CORNER RD
Practice Address - Street 2:
Practice Address - City:CHANTILLY
Practice Address - State:VA
Practice Address - Zip Code:20151-2824
Practice Address - Country:US
Practice Address - Phone:703-579-9972
Practice Address - Fax:703-817-1574
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-20
Last Update Date:2010-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAFLO-1104065-L153310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility