Provider Demographics
NPI:1154111979
Name:KEYSTONE CENTER OF INTEGRATED WELLNESS, LLC
Entity type:Organization
Organization Name:KEYSTONE CENTER OF INTEGRATED WELLNESS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF RETAIL OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:FOREMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:717-713-0033
Mailing Address - Street 1:5845 CENTRE AVE
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15206-3759
Mailing Address - Country:US
Mailing Address - Phone:412-404-7464
Mailing Address - Fax:
Practice Address - Street 1:2625 N SUSQUEHANNA TRL
Practice Address - Street 2:
Practice Address - City:SHAMOKIN DAM
Practice Address - State:PA
Practice Address - Zip Code:17876-9106
Practice Address - Country:US
Practice Address - Phone:570-361-2020
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-05-07
Last Update Date:2025-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes175F00000XOther Service ProvidersNaturopathGroup - Single Specialty