Provider Demographics
NPI:1932830932
Name:KEY WEST II
Entity Type:Organization
Organization Name:KEY WEST II
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIE
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:GIBSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-274-1269
Mailing Address - Street 1:1012 GREGORY ST
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27403-3029
Mailing Address - Country:US
Mailing Address - Phone:336-274-1269
Mailing Address - Fax:336-272-2387
Practice Address - Street 1:1722 ATHENS AVE
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27707-4312
Practice Address - Country:US
Practice Address - Phone:919-564-7543
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FAMILY AFFAIR CARE GROUP MANAGEMENT, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-06-21
Last Update Date:2022-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes315P00000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Intellectual Disabilities