Healthcare Provider Details

I. General information

NPI: 1750304044
Provider Name (Legal Business Name): KEYSTONE CONTINUUM, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/26/2006
Last Update Date: 09/30/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

332 HOSPITAL RD
MOUNTAIN CITY TN
37683-4309
US

IV. Provider business mailing address

332 HOSPITAL RD PO BOX 58
MOUNTAIN CITY TN
37683-4309
US

V. Phone/Fax

Practice location:
  • Phone: 423-727-9898
  • Fax: 423-727-9899
Mailing address:
  • Phone: 423-727-9898
  • Fax: 423-727-9899

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code323P00000X
TaxonomyPsychiatric Residential Treatment Facility
License NumberL237M20661497
License Number StateTN

VIII. Authorized Official

Name: PAUL KIRKHAM
Title or Position: ADMINISTRATOR
Credential:
Phone: 423-727-9898