Provider Demographics
NPI:1346988581
Name:KEYSTONE HOME HEALTH D4 LLC
Entity Type:Organization
Organization Name:KEYSTONE HOME HEALTH D4 LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:GARBACIK
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:727-669-2777
Mailing Address - Street 1:6620 SOUTHPOINT DR S STE 501
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32216-0958
Mailing Address - Country:US
Mailing Address - Phone:727-669-2777
Mailing Address - Fax:727-255-6338
Practice Address - Street 1:6620 SOUTHPOINT DR S STE 501
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32216-0958
Practice Address - Country:US
Practice Address - Phone:727-669-2777
Practice Address - Fax:727-255-6338
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-26
Last Update Date:2022-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health