Organization
KENA RAE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. ANTHONY BASTONE (CHIEF EXECUTIVE OFFICER)
(302) 765-7802
Entity
Organization
Contact information
Practice address
7310 RITCHIE HWY STE 200 #1018, GLEN BURNIE, MD 21061
(800) 546-1107
Mailing address
7310 RITCHIE HWY STE 200 #1018, GLEN BURNIE, MD 21061
(800) 546-1107
Taxonomy
Speciality
Code
Description
License number
State
251K00000X
Public Health or Welfare Agency
—
—
302R00000X
Health Maintenance Organization
Primary
—
—
Other
Enumeration date
09/19/2023
Last updated
09/21/2023
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