Organization
KEELLEN, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. MARY ELLEN JOHNSON (OWNER)
(919) 529-1965
Entity
Organization
Contact information
Practice address
313 PARK AVE, CREEDMOOR, NC 27522-0313
(919) 529-1965
(919) 764-9731
Mailing address
PO BOX 14, CREEDMOOR, NC 27522-0014
(919) 529-1965
(919) 764-9731
Taxonomy
Speciality
Code
Description
License number
State
322D00000X
Emotionally Disturbed Childrens' Residential Treatment Facility
Primary
MHL-030-028
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
6603254
—
NC
Enumeration date
10/25/2006
Last updated
04/02/2009
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