Provider Demographics
NPI:1255334009
Name:KEYSTONE SUBSTANCE ABUSE SERVICES
Entity Type:Organization
Organization Name:KEYSTONE SUBSTANCE ABUSE SERVICES
Other - Org Name:YORK COUNTY COUNCIL ON ALCOHOL AND DRUG ABUSE
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:KERRI
Authorized Official - Middle Name:
Authorized Official - Last Name:MCGUIRE
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, LPC, NCC
Authorized Official - Phone:803-323-6851
Mailing Address - Street 1:PO BOX 4437
Mailing Address - Street 2:
Mailing Address - City:ROCK HILL
Mailing Address - State:SC
Mailing Address - Zip Code:29732-6437
Mailing Address - Country:US
Mailing Address - Phone:803-324-1800
Mailing Address - Fax:803-328-3831
Practice Address - Street 1:199 S HERLONG AVE
Practice Address - Street 2:
Practice Address - City:ROCK HILL
Practice Address - State:SC
Practice Address - Zip Code:29732-1186
Practice Address - Country:US
Practice Address - Phone:803-324-1800
Practice Address - Fax:803-328-3831
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-05-24
Last Update Date:2023-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YA0400X, 251S00000X, 291U00000X
SCDHEC OTP-44261QR0405X
SCDHEC ITP-025324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty
No261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use DisorderGroup - Single Specialty
No291U00000XLaboratoriesClinical Medical Laboratory
No324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCAD12YK-SCMedicaid
19121OtherCARF CERTIFICATION NUMBER
SCL00915Medicaid