Provider Demographics
NPI:1033592290
Name:KEYSTONE FAMILY SUPPORT, INC.
Entity Type:Organization
Organization Name:KEYSTONE FAMILY SUPPORT, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:HOLLY
Authorized Official - Middle Name:
Authorized Official - Last Name:STOCK
Authorized Official - Suffix:
Authorized Official - Credentials:TEACHER
Authorized Official - Phone:801-645-6451
Mailing Address - Street 1:195 E 550 N
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:UT
Mailing Address - Zip Code:84025-2522
Mailing Address - Country:US
Mailing Address - Phone:801-645-6451
Mailing Address - Fax:
Practice Address - Street 1:2558 VALLEY VIEW DR
Practice Address - Street 2:
Practice Address - City:LAYTON
Practice Address - State:UT
Practice Address - Zip Code:84040-7654
Practice Address - Country:US
Practice Address - Phone:801-645-6451
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:KEYSTONE FAMILY SUPPORT, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-07-07
Last Update Date:2015-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT12525322D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children