Healthcare Provider Details

I. General information

NPI: 1912892274
Provider Name (Legal Business Name): KEITH SPECIALIZED RESIDENTIAL SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/09/2025
Last Update Date: 06/09/2025
Certification Date: 06/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3088 KEITH DR
FLINT MI
48507-1206
US

IV. Provider business mailing address

3060 S DYE RD
FLINT MI
48507-1078
US

V. Phone/Fax

Practice location:
  • Phone: 833-478-9464
  • Fax: 810-462-1093
Mailing address:
  • Phone: 833-478-9464
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3104A0625X
TaxonomyAssisted Living Facility (Mental Illness)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3104A0630X
TaxonomyAssisted Living Facility (Behavioral Disturbances)
License Number
License Number State

VIII. Authorized Official

Name: CHRISTINE BERTRAM
Title or Position: PRESIDENT
Credential:
Phone: 248-705-9802