Provider Demographics
NPI:1689812414
Name:KEYSTONE COMMONS, LLC
Entity Type:Organization
Organization Name:KEYSTONE COMMONS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:BETH
Authorized Official - Middle Name:LESLIE
Authorized Official - Last Name:EDELBERG-CARDILLO
Authorized Official - Suffix:
Authorized Official - Credentials:MED, LSW
Authorized Official - Phone:413-583-6611
Mailing Address - Street 1:460 WEST ST
Mailing Address - Street 2:
Mailing Address - City:LUDLOW
Mailing Address - State:MA
Mailing Address - Zip Code:01056-1003
Mailing Address - Country:US
Mailing Address - Phone:413-583-6611
Mailing Address - Fax:413-583-7701
Practice Address - Street 1:460 WEST ST
Practice Address - Street 2:
Practice Address - City:LUDLOW
Practice Address - State:MA
Practice Address - Zip Code:01056-1003
Practice Address - Country:US
Practice Address - Phone:413-583-6611
Practice Address - Fax:413-583-7701
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-02
Last Update Date:2009-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MANO NUMBER ISSUED310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility