Provider Demographics
NPI:1326537648
Name:KEYSTONE NURSING AND REHAB OF LANCASTER LLC
Entity Type:Organization
Organization Name:KEYSTONE NURSING AND REHAB OF LANCASTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:AKIVA
Authorized Official - Middle Name:
Authorized Official - Last Name:GLATZER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:516-505-0000
Mailing Address - Street 1:99 W HAWTHORNE AVE STE 508
Mailing Address - Street 2:
Mailing Address - City:VALLEY STREAM
Mailing Address - State:NY
Mailing Address - Zip Code:11580-6101
Mailing Address - Country:US
Mailing Address - Phone:718-879-3036
Mailing Address - Fax:
Practice Address - Street 1:425 N DUKE ST
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17602-4905
Practice Address - Country:US
Practice Address - Phone:516-505-0000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-02
Last Update Date:2018-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility