Provider Demographics
NPI:1811325368
Name:KEE TO INDEPENDENT GROWTH INC
Entity type:Organization
Organization Name:KEE TO INDEPENDENT GROWTH INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT, E.D.
Authorized Official - Prefix:MRS
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:
Authorized Official - Last Name:LE'QUE
Authorized Official - Suffix:
Authorized Official - Credentials:BS, LPN
Authorized Official - Phone:518-309-3557
Mailing Address - Street 1:PO BOX 243
Mailing Address - Street 2:
Mailing Address - City:BALLSTON SPA
Mailing Address - State:NY
Mailing Address - Zip Code:12020
Mailing Address - Country:US
Mailing Address - Phone:518-309-3557
Mailing Address - Fax:518-309-3558
Practice Address - Street 1:40 CHURCH AVE
Practice Address - Street 2:
Practice Address - City:BALLSTON SPA
Practice Address - State:NY
Practice Address - Zip Code:12020-1903
Practice Address - Country:US
Practice Address - Phone:518-309-3557
Practice Address - Fax:518-309-3558
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-21
Last Update Date:2013-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY251B00000X, 311500000X, 311Z00000X, 251V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251V00000XAgenciesVoluntary or Charitable
No251B00000XAgenciesCase Management
No311500000XNursing & Custodial Care FacilitiesAlzheimer Center (Dementia Center)
No311Z00000XNursing & Custodial Care FacilitiesCustodial Care Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02949544Medicaid
NY02950470Medicaid
NY02991477Medicaid