Provider Demographics
NPI:1629415435
Name:KEYSTONE CENTER FOR FAMILY DEVELOPEMENT
Entity Type:Organization
Organization Name:KEYSTONE CENTER FOR FAMILY DEVELOPEMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:SUNDAY
Authorized Official - Middle Name:
Authorized Official - Last Name:NWEGBO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:267-241-8928
Mailing Address - Street 1:548 S 4TH ST
Mailing Address - Street 2:
Mailing Address - City:DARBY
Mailing Address - State:PA
Mailing Address - Zip Code:19023-3118
Mailing Address - Country:US
Mailing Address - Phone:267-241-8928
Mailing Address - Fax:
Practice Address - Street 1:548 S 4TH ST
Practice Address - Street 2:
Practice Address - City:DARBY
Practice Address - State:PA
Practice Address - Zip Code:19023-3118
Practice Address - Country:US
Practice Address - Phone:267-241-8928
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-03
Last Update Date:2013-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities