Provider Demographics
NPI:1134819915
Name:KEYS, DELISHIA DENE
Entity type:Individual
Prefix:
First Name:DELISHIA
Middle Name:DENE
Last Name:KEYS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 DWIGHT AVE SE
Mailing Address - Street 2:
Mailing Address - City:MASSILLON
Mailing Address - State:OH
Mailing Address - Zip Code:44646-8050
Mailing Address - Country:US
Mailing Address - Phone:234-458-7363
Mailing Address - Fax:
Practice Address - Street 1:19 DWIGHT AVE SE
Practice Address - Street 2:
Practice Address - City:MASSILLON
Practice Address - State:OH
Practice Address - Zip Code:44646-8050
Practice Address - Country:US
Practice Address - Phone:234-458-7363
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-15
Last Update Date:2023-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care