Organization
KESHA HEALTH CARE SERVICE,LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
NAKESHA SHONEASE YOUNG (OWNER)
(863) 595-6212
Entity
Organization
Contact information
Practice address
135 MANSEAU DR, WINTER HAVEN, FL 33880-1719
(863) 595-6212
Mailing address
135 MANSEAU DR, WINTER HAVEN, FL 33880-1719
(863) 595-6212
(863) 875-4742
Taxonomy
Speciality
Code
Description
License number
State
305R00000X
Preferred Provider Organization
Primary
001447200
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
001447200
—
FL
05
—
001447201
—
FL
05
—
003167300
—
FL
Enumeration date
04/11/2011
Last updated
04/11/2011
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