Provider Demographics
NPI:1164984373
Name:KEYS (KEEPING EVERY YOUTH SAFE)
Entity Type:Organization
Organization Name:KEYS (KEEPING EVERY YOUTH SAFE)
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICIAL ORGANIZATION PROVIDER
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:EARL
Authorized Official - Last Name:DONALD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:501-398-1987
Mailing Address - Street 1:2717 SO RINGO STREET
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72206-6554
Mailing Address - Country:US
Mailing Address - Phone:501-398-1987
Mailing Address - Fax:
Practice Address - Street 1:2717 SO RINGO STREET
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72206-6554
Practice Address - Country:US
Practice Address - Phone:501-398-1987
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-05
Last Update Date:2019-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental TherapistGroup - Single Specialty