Provider Demographics
NPI:1760619399
Name:KEYSTONE HOME CARE
Entity Type:Organization
Organization Name:KEYSTONE HOME CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:RAY
Authorized Official - Last Name:ANCTIL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:617-259-1001
Mailing Address - Street 1:535 BOYLSTON ST
Mailing Address - Street 2:5TH FLOOR
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02116-3720
Mailing Address - Country:US
Mailing Address - Phone:617-259-1001
Mailing Address - Fax:617-259-1009
Practice Address - Street 1:535 BOYLSTON ST
Practice Address - Street 2:5TH FLOOR
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02116-3720
Practice Address - Country:US
Practice Address - Phone:617-259-1001
Practice Address - Fax:617-259-1009
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-22
Last Update Date:2009-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health