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General NPI Number Information
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NPI Number | 1154111979
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Entity Type | Organization
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Legal Business Name | KEYSTONE CENTER OF INTEGRATED WELLNESS, LLC
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Dates
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Enumeration Date | 05/07/2025
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Last Update Date | 05/07/2025
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Provider Practice Location Address
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Address Line | 2625 N SUSQUEHANNA TRL
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City | SHAMOKIN DAM
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State | PA
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Zip | 17876-9106
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Country | US
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Telephone | 570-361-2020
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Fax |
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Provider Business Mailing Address
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Address Line | 5845 CENTRE AVE
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City | PITTSBURGH
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State | PA
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Zip | 15206-3759
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Country | US
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Telephone | 412-404-7464
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Fax |
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Authorized Official
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Title or Position | DIRECTOR OF RETAIL OPERATIONS
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Name | MELISSA FOREMAN
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Credential |
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Telephone | 717-713-0033
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 175F00000X
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Taxonomy Name | Naturopath
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License Number |
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License Number State |
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