Provider Demographics
NPI:1245709351
Name:KEYSTONE NURSING SERVICES LLC
Entity type:Organization
Organization Name:KEYSTONE NURSING SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:SACKIE
Authorized Official - Last Name:FAHNBUTU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:443-866-4031
Mailing Address - Street 1:115 SUDBROOK LN STE D
Mailing Address - Street 2:
Mailing Address - City:PIKESVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21208-4184
Mailing Address - Country:US
Mailing Address - Phone:443-866-4031
Mailing Address - Fax:
Practice Address - Street 1:115 SUDBROOK LN STE D
Practice Address - Street 2:
Practice Address - City:PIKESVILLE
Practice Address - State:MD
Practice Address - Zip Code:21208-4184
Practice Address - Country:US
Practice Address - Phone:443-866-4031
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-19
Last Update Date:2019-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health