Healthcare Provider Details

I. General information

NPI: 1700659760
Provider Name (Legal Business Name): IT'S THE KEY TO LIFE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/01/2023
Last Update Date: 01/03/2024
Certification Date: 01/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

619 WINTERS AVE REAR
HAZLE TOWNSHIP PA
18202-3624
US

IV. Provider business mailing address

619 WINTERS AVE REAR
HAZLE TOWNSHIP PA
18202-3624
US

V. Phone/Fax

Practice location:
  • Phone: 267-312-1940
  • Fax:
Mailing address:
  • Phone: 267-312-1940
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number StateNULL

VIII. Authorized Official

Name: JUDITH SANTIAGO
Title or Position: OWNER
Credential:
Phone: 267-312-1940