Individual
MR. KEILAND MAURICE HENDERSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
151 W CLEVELAND ST, STOCKTON, CA 95204-5306
(916) 470-8628
Mailing address
350 KRESGE LN., SPARKS, NV 89431
(775) 359-9200
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
—
—
171W00000X
Contractor
Primary
—
—
Other
Enumeration date
01/07/2011
Last updated
06/07/2023
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