Healthcare Provider Details

I. General information

NPI: 1063431294
Provider Name (Legal Business Name): KEYSTONE MEMPHIS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/19/2006
Last Update Date: 07/25/2023
Certification Date: 07/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7900 LOWRANCE RD
MEMPHIS TN
38125-2838
US

IV. Provider business mailing address

7900 LOWRANCE RD
MEMPHIS TN
38125-2838
US

V. Phone/Fax

Practice location:
  • Phone: 931-551-8013
  • Fax: 901-758-2156
Mailing address:
  • Phone: 931-551-8013
  • Fax: 901-758-2156

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code283Q00000X
TaxonomyPsychiatric Hospital
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code323P00000X
TaxonomyPsychiatric Residential Treatment Facility
License NumberL237M31256092
License Number StateTN

VIII. Authorized Official

Name: STEVE FILTON
Title or Position: EXECUTIVE VP/CFO
Credential:
Phone: 610-768-3300