Provider Demographics
NPI:1609976950
Name:KEYSTONE HOME HEALTH, INC.
Entity Type:Organization
Organization Name:KEYSTONE HOME HEALTH, INC.
Other - Org Name:MEDBRIDGE HOME HEALTH INC.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:S
Authorized Official - Last Name:GARBACIK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:727-669-2777
Mailing Address - Street 1:9600 KOGER BLVD N STE 225
Mailing Address - Street 2:
Mailing Address - City:SAINT PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33702-2467
Mailing Address - Country:US
Mailing Address - Phone:727-669-2777
Mailing Address - Fax:727-669-2778
Practice Address - Street 1:9600 KOGER BLVD N STE 225
Practice Address - Street 2:
Practice Address - City:SAINT PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33702-2467
Practice Address - Country:US
Practice Address - Phone:276-692-7777
Practice Address - Fax:727-669-2778
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-25
Last Update Date:2023-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL299992497251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL299992497OtherHOME HEALTH LIC. #