Provider Demographics
NPI:1902825151
Name:KEYSTONE CONTINUUM, LLC
Entity Type:Organization
Organization Name:KEYSTONE CONTINUUM, LLC
Other - Org Name:NATCHEZ TRACE YOUTH ACADEMY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:TOM
Authorized Official - Middle Name:
Authorized Official - Last Name:HENNESSEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:931-296-1183
Mailing Address - Street 1:415 SEVEN HAWKS LN
Mailing Address - Street 2:
Mailing Address - City:WAVERLY
Mailing Address - State:TN
Mailing Address - Zip Code:37185-2536
Mailing Address - Country:US
Mailing Address - Phone:931-296-1183
Mailing Address - Fax:931-296-7576
Practice Address - Street 1:415 SEVEN HAWKS LN
Practice Address - Street 2:
Practice Address - City:WAVERLY
Practice Address - State:TN
Practice Address - Zip Code:37185-2536
Practice Address - Country:US
Practice Address - Phone:931-296-1183
Practice Address - Fax:931-296-7576
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNSO09869A323P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes323P00000XResidential Treatment FacilitiesPsychiatric Residential Treatment Facility