MEDICARE: KEYSTONE HALLS INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251B00000X	Case Management Agency	1706AD576001	FL

General Provider Information

NPI Number	:	1881988806
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KEYSTONE HALLS INC

Provider Business Mailing Address
First Line	:	1420 SW 3RD AVE
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33315-1509
Country	:	US
Telephone Number	:	954-763-2300
Fax Number	:

Provider Business Practice Location Address
First Line	:	1420 SW 3RD AVE
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33315-1509
Country	:	US
Telephone Number	:	954-763-2300
Fax Number	:

Authorized Official
Title or Position	:	CHEIF EXECUTIVE OFFICER
Name	:	RONALD S MALEC
Credential	:
Telephone Number	:	954-763-2300

Provider Enumeration Date	:	06/07/2011
Last Update Date	:	06/07/2011

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