Provider Demographics
NPI:1578935011
Name:NEW KEYS TO LIFE SPECIALIZE CARE HOME CARE
Entity Type:Organization
Organization Name:NEW KEYS TO LIFE SPECIALIZE CARE HOME CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:LASHAWN
Authorized Official - Middle Name:
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-422-5183
Mailing Address - Street 1:115 LAKE VILLAGE BLVD
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48120-1665
Mailing Address - Country:US
Mailing Address - Phone:313-422-5183
Mailing Address - Fax:
Practice Address - Street 1:115 LAKE VILLAGE BLVD
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48120-1665
Practice Address - Country:US
Practice Address - Phone:313-422-5183
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-23
Last Update Date:2015-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization