Provider Demographics
NPI:1336547611
Name:KEYSTONE HOSPICE INC
Entity Type:Organization
Organization Name:KEYSTONE HOSPICE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:AARON
Authorized Official - Middle Name:
Authorized Official - Last Name:ANTONIO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:213-568-3988
Mailing Address - Street 1:638 S. VAN NESS AVE.
Mailing Address - Street 2:UNIT A
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90005-3201
Mailing Address - Country:US
Mailing Address - Phone:213-568-3988
Mailing Address - Fax:213-568-3988
Practice Address - Street 1:638 S. VAN NESS AVE
Practice Address - Street 2:UNIT A
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90005-3201
Practice Address - Country:US
Practice Address - Phone:213-568-3988
Practice Address - Fax:213-568-3988
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-18
Last Update Date:2017-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based