Provider Demographics
NPI:1114449428
Name:KEY WEST PD, LLC
Entity Type:Organization
Organization Name:KEY WEST PD, LLC
Other - Org Name:ISLAND PRIVATE CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SR. VP ADMINISTRATION
Authorized Official - Prefix:MR
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:T
Authorized Official - Last Name:LYLES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:502-891-1044
Mailing Address - Street 1:9510 ORMSBY STATION RD STE 300
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40223-5016
Mailing Address - Country:US
Mailing Address - Phone:502-891-1000
Mailing Address - Fax:502-891-1427
Practice Address - Street 1:22978 OVERSEAS HWY
Practice Address - Street 2:
Practice Address - City:CUDJOE KEY
Practice Address - State:FL
Practice Address - Zip Code:33042-4254
Practice Address - Country:US
Practice Address - Phone:305-298-4466
Practice Address - Fax:305-289-4433
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-10
Last Update Date:2017-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health