Provider Demographics
NPI:1760503247
Name:KEYSTONE SERVICE SYSTEMS, INC
Entity Type:Organization
Organization Name:KEYSTONE SERVICE SYSTEMS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:
Authorized Official - Last Name:HOOKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:717-232-7509
Mailing Address - Street 1:4391 STURBRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:HARRISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17110-3673
Mailing Address - Country:US
Mailing Address - Phone:717-232-7509
Mailing Address - Fax:717-232-6687
Practice Address - Street 1:8182 ADAMS DR
Practice Address - Street 2:
Practice Address - City:HUMMELSTOWN
Practice Address - State:PA
Practice Address - Zip Code:17036-8624
Practice Address - Country:US
Practice Address - Phone:717-232-7509
Practice Address - Fax:717-232-6687
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-03
Last Update Date:2020-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1000010380884Medicaid
PA100001038 0366Medicaid