Healthcare Provider Details

I. General information

NPI: 1063282812
Provider Name (Legal Business Name): KEYSTONECARE HOME HEALTH, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/03/2024
Last Update Date: 09/02/2025
Certification Date: 12/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8765 STENTON AVE
WYNDMOOR PA
19038-8317
US

IV. Provider business mailing address

8765 STENTON AVE
WYNDMOOR PA
19038-8317
US

V. Phone/Fax

Practice location:
  • Phone: 215-836-2440
  • Fax: 215-836-5209
Mailing address:
  • Phone: 215-836-2440
  • Fax: 215-836-5209

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number StateNULL
# 5
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number StateNULL
# 6
Primary TaxonomyN
Taxonomy Code2081H0002X
TaxonomyHospice and Palliative Medicine (Physical Medicine & Rehabilitation) Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: GAIL INDERWIES
Title or Position: EXECUTIVE DIRECTOR
Credential: RN
Phone: 215-836-2440