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General NPI Number Information
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NPI Number | 1063961035
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Entity Type | Organization
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Legal Business Name | KEYS 2 A 2ND CHANCE, LLC
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Dates
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Enumeration Date | 10/01/2016
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Last Update Date | 10/01/2016
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Provider Practice Location Address
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Address Line | 3268 ARIS ST NW
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City | WARREN
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State | OH
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Zip | 44485-1605
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Country | US
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Telephone | 330-506-6035
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Fax |
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Provider Business Mailing Address
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Address Line | 3268 ARIS ST NW
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City | WARREN
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State | OH
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Zip | 44485-1605
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Country | US
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Telephone | 330-506-6035
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | MS. VIRGINIA L HOLMES
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Credential | CDCA I
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Telephone | 330-506-6035
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 343900000X
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Taxonomy Name | Non-emergency Medical Transport (VAN)
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number | 160007
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License Number State | OH
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