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General NPI Number Information
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NPI Number | 1356360580
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Entity Type | Organization
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Legal Business Name | KEYSTONE NEWPORT NEWS, LLC
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Dates
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Enumeration Date | 07/19/2006
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Last Update Date | 07/02/2021
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Provider Practice Location Address
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Address Line | 17579 WARWICK BLVD
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City | NEWPORT NEWS
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State | VA
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Zip | 23603-1343
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Country | US
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Telephone | 757-888-0400
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Fax | 757-888-0359
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Provider Business Mailing Address
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Address Line | 17579 WARWICK BLVD
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City | NEWPORT NEWS
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State | VA
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Zip | 23603
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Country | US
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Telephone | 757-888-0400
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Fax | 757-888-0359
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Authorized Official
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Title or Position | CEO
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Name | MR. LARRY KIRKLAND
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Credential | MS, LMHC
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Telephone | 757-888-0400
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 283Q00000X
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Taxonomy Name | Psychiatric Hospital
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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 | 320800000X
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Taxonomy Name | Mental Illness Community Based Residential Treatment Facility
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License Number |
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License Number State |
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