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General NPI Number Information
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NPI Number | 1780756692
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Entity Type | Organization
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Legal Business Name | KEYSTONE MEMPHIS, LLC
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Dates
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Enumeration Date | 11/15/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 711 HWY 51 BY-PASS
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City | DYERSBURG
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State | TN
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Zip | 38024
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Country | US
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Telephone | 731-286-2861
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Fax | 731-286-2869
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Provider Business Mailing Address
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Address Line | 711 HWY 51 BY-PASS
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City | DYERSBURG
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State | TN
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Zip | 38024
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Country | US
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Telephone | 731-286-2861
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Fax | 731-286-2869
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | RUSTY GOAD
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Credential |
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Telephone | 731-286-2861
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 323P00000X
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Taxonomy Name | Psychiatric Residential Treatment Facility
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License Number |
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License Number State |
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