Healthcare Provider Details

I. General information

NPI: 1578095618
Provider Name (Legal Business Name): KEYS DEVELOPMENT TA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/29/2017
Last Update Date: 04/24/2023
Certification Date: 04/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7501 LIBERTY ROAD SUITES A, B, F/G & L
GWYNN OAK MD
21207-3870
US

IV. Provider business mailing address

7501 LIBERTY ROAD SUITES A, B, F/G & L
GWYNN OAK MD
21207-3870
US

V. Phone/Fax

Practice location:
  • Phone: 443-429-2536
  • Fax: 443-429-2168
Mailing address:
  • Phone: 443-429-2536
  • Fax: 443-429-2168

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License NumberMH-1995
License Number StateMD

VIII. Authorized Official

Name: ERIKA TRACEY ROBINSON
Title or Position: DIRECTOR OF OPERATIONS
Credential:
Phone: 443-429-2536