Provider Demographics
NPI:1558135236
Name:KEYS TO LIFE
Entity Type:Organization
Organization Name:KEYS TO LIFE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ARKEVIUS
Authorized Official - Middle Name:
Authorized Official - Last Name:FORREST
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-569-4105
Mailing Address - Street 1:808 MULBERRY ST SW
Mailing Address - Street 2:
Mailing Address - City:LENOIR
Mailing Address - State:NC
Mailing Address - Zip Code:28645-5829
Mailing Address - Country:US
Mailing Address - Phone:704-569-4105
Mailing Address - Fax:
Practice Address - Street 1:808 MULBERRY ST SW
Practice Address - Street 2:
Practice Address - City:LENOIR
Practice Address - State:NC
Practice Address - Zip Code:28645-5829
Practice Address - Country:US
Practice Address - Phone:704-569-4105
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-13
Last Update Date:2023-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health