Healthcare Provider Details

I. General information

NPI: 1063961035
Provider Name (Legal Business Name): KEYS 2 A 2ND CHANCE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/01/2016
Last Update Date: 10/01/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3268 ARIS ST NW
WARREN OH
44485-1605
US

IV. Provider business mailing address

3268 ARIS ST NW
WARREN OH
44485-1605
US

V. Phone/Fax

Practice location:
  • Phone: 330-506-6035
  • Fax:
Mailing address:
  • Phone: 330-506-6035
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number160007
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State

VIII. Authorized Official

Name: MS. VIRGINIA L HOLMES
Title or Position: DIRECTOR
Credential: CDCA I
Phone: 330-506-6035