Provider Demographics
NPI:1164030276
Name:KEYSTONE HEALTHCARE SERVICES LLC
Entity Type:Organization
Organization Name:KEYSTONE HEALTHCARE SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSING / COMPLIANCE
Authorized Official - Prefix:
Authorized Official - First Name:RENEE
Authorized Official - Middle Name:
Authorized Official - Last Name:LAWSON
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:307-856-2600
Mailing Address - Street 1:614 E MAIN ST STE C
Mailing Address - Street 2:
Mailing Address - City:RIVERTON
Mailing Address - State:WY
Mailing Address - Zip Code:82501-4460
Mailing Address - Country:US
Mailing Address - Phone:307-856-2600
Mailing Address - Fax:307-856-2400
Practice Address - Street 1:787 PINE VALLEY DR STE C
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15239-2832
Practice Address - Country:US
Practice Address - Phone:724-571-7685
Practice Address - Fax:724-558-9555
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-15
Last Update Date:2020-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health