Provider Demographics
NPI:1043878721
Name:KEYSVILLE LTC MANAGEMENT LLC
Entity Type:Organization
Organization Name:KEYSVILLE LTC MANAGEMENT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:ANDREW
Authorized Official - Last Name:PARKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-480-7564
Mailing Address - Street 1:1005 GA HIGHWAY 88
Mailing Address - Street 2:
Mailing Address - City:BLYTHE
Mailing Address - State:GA
Mailing Address - Zip Code:30805-3911
Mailing Address - Country:US
Mailing Address - Phone:706-547-2591
Mailing Address - Fax:706-547-2591
Practice Address - Street 1:1005 GA HIGHWAY 88
Practice Address - Street 2:
Practice Address - City:BLYTHE
Practice Address - State:GA
Practice Address - Zip Code:30805-3911
Practice Address - Country:US
Practice Address - Phone:706-547-2591
Practice Address - Fax:706-547-2591
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-29
Last Update Date:2019-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility