Provider Demographics
NPI:1841348471
Name:KEETONI CASE MANAGEMENT, LLC
Entity type:Organization
Organization Name:KEETONI CASE MANAGEMENT, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JACQUELYN
Authorized Official - Middle Name:M
Authorized Official - Last Name:KEETON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:505-438-8288
Mailing Address - Street 1:4001 OFFICE COURT DR, SUITE 407
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87507
Mailing Address - Country:US
Mailing Address - Phone:505-438-8288
Mailing Address - Fax:505-438-0880
Practice Address - Street 1:4001 OFFICE COURT DR, SUITE 407
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87507
Practice Address - Country:US
Practice Address - Phone:505-438-8288
Practice Address - Fax:505-438-0880
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMD2343251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management