Provider Demographics
NPI:1932477601
Name:KEYSTONE RECOVERY, L.L.C.
Entity Type:Organization
Organization Name:KEYSTONE RECOVERY, L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JAY
Authorized Official - Middle Name:L
Authorized Official - Last Name:FLETCHER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:337-886-4700
Mailing Address - Street 1:808 PITT RD
Mailing Address - Street 2:
Mailing Address - City:SCOTT
Mailing Address - State:LA
Mailing Address - Zip Code:70583-4608
Mailing Address - Country:US
Mailing Address - Phone:337-886-4700
Mailing Address - Fax:337-886-4725
Practice Address - Street 1:808 PITT RD
Practice Address - Street 2:
Practice Address - City:SCOTT
Practice Address - State:LA
Practice Address - Zip Code:70583-4608
Practice Address - Country:US
Practice Address - Phone:337-886-4700
Practice Address - Fax:337-886-4725
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-08
Last Update Date:2011-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA493324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility