Provider Demographics
NPI:1790211605
Name:KEYSTONE ACHIEVEMENTS
Entity Type:Organization
Organization Name:KEYSTONE ACHIEVEMENTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:TODD
Authorized Official - Last Name:MCLANE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:719-205-5048
Mailing Address - Street 1:6070 TRADITIONS DR
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80924-6035
Mailing Address - Country:US
Mailing Address - Phone:719-205-5048
Mailing Address - Fax:
Practice Address - Street 1:5526 N ACADEMY BLVD STE 109
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80918-3688
Practice Address - Country:US
Practice Address - Phone:719-301-5100
Practice Address - Fax:719-960-2649
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-11
Last Update Date:2020-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty
No251C00000XAgenciesDay Training, Developmentally Disabled Services
No347C00000XTransportation ServicesPrivate Vehicle
No385HR2060XRespite Care FacilityRespite CareRespite Care, Intellectual and/or Developmental Disabilities, ChildGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO1790211605Medicaid