Provider Demographics
NPI:1750304044
Name:KEYSTONE CONTINUUM, LLC
Entity Type:Organization
Organization Name:KEYSTONE CONTINUUM, LLC
Other - Org Name:MOUNTAIN YOUTH ACADEMY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:KIRKHAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:423-727-9898
Mailing Address - Street 1:332 HOSPITAL RD
Mailing Address - Street 2:PO BOX 58
Mailing Address - City:MOUNTAIN CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37683-4309
Mailing Address - Country:US
Mailing Address - Phone:423-727-9898
Mailing Address - Fax:423-727-9899
Practice Address - Street 1:332 HOSPITAL RD
Practice Address - Street 2:
Practice Address - City:MOUNTAIN CITY
Practice Address - State:TN
Practice Address - Zip Code:37683-4309
Practice Address - Country:US
Practice Address - Phone:423-727-9898
Practice Address - Fax:423-727-9899
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-26
Last Update Date:2009-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNL237M20661497323P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes323P00000XResidential Treatment FacilitiesPsychiatric Residential Treatment Facility