Provider Demographics
NPI:1659792885
Name:KEYSTONE HEALTH CARE SERVICES
Entity Type:Organization
Organization Name:KEYSTONE HEALTH CARE SERVICES
Other - Org Name:KEYSTONE FAMILY HEALTH CARE SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARTIN
Authorized Official - Middle Name:CHOCOMANI
Authorized Official - Last Name:NGENGWE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:240-498-2661
Mailing Address - Street 1:1300 STONE RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:SINKING SPRING
Mailing Address - State:PA
Mailing Address - Zip Code:19608-9538
Mailing Address - Country:US
Mailing Address - Phone:240-498-2661
Mailing Address - Fax:301-220-0226
Practice Address - Street 1:1300 STONE RIDGE RD
Practice Address - Street 2:
Practice Address - City:SINKING SPRING
Practice Address - State:PA
Practice Address - Zip Code:19608-9538
Practice Address - Country:US
Practice Address - Phone:240-498-2661
Practice Address - Fax:301-220-0226
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-13
Last Update Date:2013-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAM231251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health