Provider Demographics
NPI:1417111543
Name:KEYSTONE FAMILY SERVICES LLC
Entity Type:Organization
Organization Name:KEYSTONE FAMILY SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FINANCIAL DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:KENTON
Authorized Official - Middle Name:A
Authorized Official - Last Name:WATTS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-899-0266
Mailing Address - Street 1:1008 BROOKSTOWN AVE
Mailing Address - Street 2:SUITE C2
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27101-2562
Mailing Address - Country:US
Mailing Address - Phone:336-899-0266
Mailing Address - Fax:206-202-5033
Practice Address - Street 1:1008 BROOKSTOWN AVE
Practice Address - Street 2:SUITE C2
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27101-2562
Practice Address - Country:US
Practice Address - Phone:336-899-0266
Practice Address - Fax:206-202-5033
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-17
Last Update Date:2008-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health