Provider Demographics
NPI:1952539314
Name:KEYSTONE YOUTH SERVICES, INC.
Entity type:Organization
Organization Name:KEYSTONE YOUTH SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:GAYLAND
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:OLIVER
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:336-456-7705
Mailing Address - Street 1:4411 BELFIELD DR
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27405-6313
Mailing Address - Country:US
Mailing Address - Phone:336-456-7705
Mailing Address - Fax:
Practice Address - Street 1:4411 BELFIELD DR
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27405-6313
Practice Address - Country:US
Practice Address - Phone:336-456-7705
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-24
Last Update Date:2009-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCMHL041912322D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children