Provider Demographics
NPI:1205627288
Name:KEELEY, ANDRE (CNA)
Entity type:Individual
Prefix:MR
First Name:ANDRE
Middle Name:
Last Name:KEELEY
Suffix:
Gender:M
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6407 NE 108TH AVE
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98662-5385
Mailing Address - Country:US
Mailing Address - Phone:360-360-4911
Mailing Address - Fax:360-360-4468
Practice Address - Street 1:6407 NE 108TH AVE
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98662-5385
Practice Address - Country:US
Practice Address - Phone:360-360-4911
Practice Address - Fax:360-360-4468
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-16
Last Update Date:2025-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA758024311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home