Provider Demographics
NPI:1811186208
Name:KEYSTONE AUTISM SERVICES
Entity Type:Organization
Organization Name:KEYSTONE AUTISM SERVICES
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 1:124 PINE ST
Mailing Address - Street 2:
Mailing Address - City:HARRISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17101-1208
Mailing Address - Country:US
Mailing Address - Phone:717-232-7509
Mailing Address - Fax:717-232-6687
Practice Address - Street 1:124 PINE ST
Practice Address - Street 2:
Practice Address - City:HARRISBURG
Practice Address - State:PA
Practice Address - Zip Code:17101-1208
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:2007-10-22
Last Update Date:2015-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA331960251S00000X
PA2953440251T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No251T00000XAgenciesProgram of All-Inclusive Care for the Elderly (PACE) Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1020600830001Medicaid
PA1020600830003Medicaid
PA1020600830006Medicaid
PA1020600830004Medicaid