Provider Demographics
NPI:1467158162
Name:KEYSTONE HEALTHCARE SERVICES LLC
Entity Type:Organization
Organization Name:KEYSTONE HEALTHCARE SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:FLORENCE
Authorized Official - Middle Name:OLURANTI
Authorized Official - Last Name:ALLI
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:301-317-9073
Mailing Address - Street 1:8337 CHERRY LN UNIT 12
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20707-4828
Mailing Address - Country:US
Mailing Address - Phone:301-317-9073
Mailing Address - Fax:
Practice Address - Street 1:8337 CHERRY LN UNIT 12
Practice Address - Street 2:
Practice Address - City:LAUREL
Practice Address - State:MD
Practice Address - Zip Code:20707-4828
Practice Address - Country:US
Practice Address - Phone:301-317-9073
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:KEYSTONE HEALTHCARE SERVICES LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-02-03
Last Update Date:2023-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Single Specialty