Healthcare Provider Details

I. General information

NPI: 1669013629
Provider Name (Legal Business Name): KEYS COMMUNITY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/01/2019
Last Update Date: 10/13/2020
Certification Date: 10/13/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3101 N CENTRAL AVE STE 940
PHOENIX AZ
85012-2703
US

IV. Provider business mailing address

3101 N CENTRAL AVE STE 940
PHOENIX AZ
85012-2703
US

V. Phone/Fax

Practice location:
  • Phone: 602-888-3353
  • Fax:
Mailing address:
  • Phone: 602-888-3353
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name: MS. KYANTI PALMER
Title or Position: CEO
Credential:
Phone: 480-430-9685