Healthcare Provider Details

I. General information

NPI: 1346579042
Provider Name (Legal Business Name): KEY SUPPORT SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/09/2009
Last Update Date: 03/28/2022
Certification Date: 03/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1893 BILLINGSGATE CIR STE B
HENRICO VA
23238-4220
US

IV. Provider business mailing address

1893 BILLINGSGATE CIR STE B
HENRICO VA
23238-4220
US

V. Phone/Fax

Practice location:
  • Phone: 804-519-7040
  • Fax: 804-477-7900
Mailing address:
  • Phone: 804-519-7040
  • Fax: 804-477-7900

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number1503
License Number StateVA

VIII. Authorized Official

Name: MRS. PAMELA A JONES
Title or Position: CO-OWNER
Credential:
Phone: 804-519-7040