Healthcare Provider Details

I. General information

NPI: 1265356901
Provider Name (Legal Business Name): KEYSTONE INDEPENDENT LIVING INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/06/2026
Last Update Date: 08/06/2026
Certification Date: 08/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

264 GEDDING ST
AVOCA PA
18641-1006
US

IV. Provider business mailing address

100 ABINGTON EXECUTIVE PARK STE B
CLARKS SUMMIT PA
18411-2276
US

V. Phone/Fax

Practice location:
  • Phone: 570-702-8000
  • Fax:
Mailing address:
  • Phone: 570-702-8000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: ADRIENNE YORK
Title or Position: DIRECTOR OF REVENUE CYCLE
Credential:
Phone: 570-702-8000