Provider Demographics
NPI:1114559267
Name:KEYSTONE COMMUNITY RESOURCES, INC.
Entity Type:Organization
Organization Name:KEYSTONE COMMUNITY RESOURCES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ACCOUNTS RECEIVABLE COORDINATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:DAVITT
Authorized Official - Suffix:JR
Authorized Official - Credentials:DO
Authorized Official - Phone:570-702-8000
Mailing Address - Street 1:100 ABINGTON EXECUTIVE PARK STE B
Mailing Address - Street 2:
Mailing Address - City:CLARKS SUMMIT
Mailing Address - State:PA
Mailing Address - Zip Code:18411-2276
Mailing Address - Country:US
Mailing Address - Phone:570-702-8000
Mailing Address - Fax:570-702-8096
Practice Address - Street 1:336 SHERIDAN AVE
Practice Address - Street 2:
Practice Address - City:CLARKS SUMMIT
Practice Address - State:PA
Practice Address - Zip Code:18411-1458
Practice Address - Country:US
Practice Address - Phone:570-319-1482
Practice Address - Fax:570-702-8096
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-06
Last Update Date:2020-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0598747Medicaid
PA100001010Medicaid