Provider Demographics
NPI:1356360580
Name:KEYSTONE NEWPORT NEWS, LLC
Entity type:Organization
Organization Name:KEYSTONE NEWPORT NEWS, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:
Authorized Official - Last Name:KIRKLAND
Authorized Official - Suffix:
Authorized Official - Credentials:MS, LMHC
Authorized Official - Phone:757-888-0400
Mailing Address - Street 1:17579 WARWICK BLVD
Mailing Address - Street 2:
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23603
Mailing Address - Country:US
Mailing Address - Phone:757-888-0400
Mailing Address - Fax:757-888-0359
Practice Address - Street 1:17579 WARWICK BLVD
Practice Address - Street 2:
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23603-1343
Practice Address - Country:US
Practice Address - Phone:757-888-0400
Practice Address - Fax:757-888-0359
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-19
Last Update Date:2021-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness
No283Q00000XHospitalsPsychiatric Hospital
No323P00000XResidential Treatment FacilitiesPsychiatric Residential Treatment Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD416531400Medicaid
VA84114001OtherVA DEPT OF BEHAVIORAL HEALTH AND DEVELOPMENTAL SERVICES
VA0505002000Medicaid
WV0505002000Medicaid
DC035597400Medicaid
VA84114003OtherVA DEPT OF BEHAVIORAL HEALTH AND DEVELOPMENTAL SERVICES