Provider Demographics
NPI:1881084721
Name:KEYSTONE HOME HEALTH, LLC
Entity type:Organization
Organization Name:KEYSTONE HOME HEALTH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TOM
Authorized Official - Middle Name:
Authorized Official - Last Name:RICH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-580-8334
Mailing Address - Street 1:1159 E IRON EAGLE DR
Mailing Address - Street 2:SUITE 170-D
Mailing Address - City:EAGLE
Mailing Address - State:ID
Mailing Address - Zip Code:83616-6871
Mailing Address - Country:US
Mailing Address - Phone:208-209-3242
Mailing Address - Fax:208-549-7880
Practice Address - Street 1:1159 E IRON EAGLE DR
Practice Address - Street 2:SUITE 170-D
Practice Address - City:EAGLE
Practice Address - State:ID
Practice Address - Zip Code:83616-6871
Practice Address - Country:US
Practice Address - Phone:208-209-3242
Practice Address - Fax:208-549-7880
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-30
Last Update Date:2015-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health