Provider Demographics
NPI:1376249433
Name:KEY INDEPENDENT LIVING HOME
Entity Type:Organization
Organization Name:KEY INDEPENDENT LIVING HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AGENCY OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:KEYAITA
Authorized Official - Middle Name:
Authorized Official - Last Name:ROBERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:216-538-4784
Mailing Address - Street 1:19414 MAPLE HEIGHTS BLVD
Mailing Address - Street 2:
Mailing Address - City:MAPLE HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44137-2380
Mailing Address - Country:US
Mailing Address - Phone:216-538-4784
Mailing Address - Fax:
Practice Address - Street 1:19414 MAPLE HEIGHTS BLVD
Practice Address - Street 2:
Practice Address - City:MAPLE HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44137-2380
Practice Address - Country:US
Practice Address - Phone:216-538-4784
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-01
Last Update Date:2023-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes376J00000XNursing Service Related ProvidersHomemakerGroup - Multi-Specialty