Provider Demographics
NPI:1477048833
Name:KEYS DEVELOPMENT TA LLC
Entity Type:Organization
Organization Name:KEYS DEVELOPMENT TA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:ERIKA
Authorized Official - Middle Name:TRACEY
Authorized Official - Last Name:ROBINSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:443-429-2536
Mailing Address - Street 1:7501 LIBERTY RD
Mailing Address - Street 2:SUITES A, B, F/G & L
Mailing Address - City:GWYNN OAK
Mailing Address - State:MD
Mailing Address - Zip Code:21207-3870
Mailing Address - Country:US
Mailing Address - Phone:443-429-2536
Mailing Address - Fax:443-316-8290
Practice Address - Street 1:7501 LIBERTY RD
Practice Address - Street 2:SUITES A, B, F/G & L
Practice Address - City:GWYNN OAK
Practice Address - State:MD
Practice Address - Zip Code:21207-3870
Practice Address - Country:US
Practice Address - Phone:443-429-2536
Practice Address - Fax:443-429-2168
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-28
Last Update Date:2023-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDBH000907261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD=========Medicaid