# KEELLEN, LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1740365220
- **Authorized official:** MRS. MARY ELLEN JOHNSON (OWNER)
- **Authorized official phone:** (919) 529-1965

## Contact information

- **Practice address:** 313 PARK AVE, CREEDMOOR, NC 27522-0313
- **Practice address phone:** (919) 529-1965
- **Practice address fax:** (919) 764-9731
- **Mailing address:** PO BOX 14, CREEDMOOR, NC 27522-0014
- **Mailing address phone:** (919) 529-1965
- **Mailing address fax:** (919) 764-9731

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 322D00000X | Emotionally Disturbed Childrens' Residential Treatment Facility | MHL-030-028 | NC | Yes |

## Other

- **Enumeration date:** 10/25/2006
- **Last updated:** 04/02/2009

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 6603254 | — | NC |