Healthcare Provider Details

I. General information

NPI: 1124273453
Provider Name (Legal Business Name): KEYSTONE LOCAL SCHOOLS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/01/2008
Last Update Date: 12/01/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 LIBERTY ST
LAGRANGE OH
44050-9496
US

IV. Provider business mailing address

301 LIBERTY ST
LAGRANGE OH
44050-9496
US

V. Phone/Fax

Practice location:
  • Phone: 440-355-5131
  • Fax: 440-355-6052
Mailing address:
  • Phone: 440-355-5131
  • Fax: 440-355-6052

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251300000X
TaxonomyLocal Education Agency (LEA)
License Number
License Number State

VIII. Authorized Official

Name: MR. PHILLIP D. BUTTO
Title or Position: TREASURER
Credential:
Phone: 440-355-5131