Provider Demographics
NPI:1043567647
Name:KEYS2MEMORY, LLC
Entity Type:Organization
Organization Name:KEYS2MEMORY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:MS
Authorized Official - First Name:ELENA
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHJAVLAND
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:860-245-4144
Mailing Address - Street 1:23 EAST MAIN ST.
Mailing Address - Street 2:PO BOX 625
Mailing Address - City:MYSTIC
Mailing Address - State:CT
Mailing Address - Zip Code:06355-0625
Mailing Address - Country:US
Mailing Address - Phone:860-245-4144
Mailing Address - Fax:860-245-4145
Practice Address - Street 1:20 BURROWS ST
Practice Address - Street 2:
Practice Address - City:MYSTIC
Practice Address - State:CT
Practice Address - Zip Code:06355-2445
Practice Address - Country:US
Practice Address - Phone:860-245-4144
Practice Address - Fax:860-245-4145
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-14
Last Update Date:2014-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002017363LA2200X, 363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontologyGroup - Multi-Specialty
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004020178Medicaid
CT500000409 C00814Medicare PIN
CT004020178Medicaid