Provider Demographics
NPI:1184969271
Name:KEYSTONE ADVANCED BEHAVIORAL HEALTHCARE
Entity type:Organization
Organization Name:KEYSTONE ADVANCED BEHAVIORAL HEALTHCARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:WENDY
Authorized Official - Middle Name:NUSS
Authorized Official - Last Name:ZUBENKO
Authorized Official - Suffix:
Authorized Official - Credentials:EDD, MSN, PMHCNS-BC
Authorized Official - Phone:724-719-2303
Mailing Address - Street 1:12300 PERRY HIGHWAY
Mailing Address - Street 2:SUITE 204
Mailing Address - City:WEXFORD
Mailing Address - State:PA
Mailing Address - Zip Code:15090-7612
Mailing Address - Country:US
Mailing Address - Phone:724-719-2303
Mailing Address - Fax:724-719-2303
Practice Address - Street 1:12300 PERRY HIGHWAY
Practice Address - Street 2:SUITE 204
Practice Address - City:WEXFORD
Practice Address - State:PA
Practice Address - Zip Code:15090-7612
Practice Address - Country:US
Practice Address - Phone:724-719-2303
Practice Address - Fax:724-719-2303
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-30
Last Update Date:2019-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACNS000026364SP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes364SP0809XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, AdultGroup - Single Specialty