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General NPI Number Information
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NPI Number | 1881988806
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Entity Type | Organization
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Legal Business Name | KEYSTONE HALLS INC
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Dates
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Enumeration Date | 06/07/2011
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Last Update Date | 06/07/2011
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Provider Practice Location Address
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Address Line | 1420 SW 3RD AVE
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City | FORT LAUDERDALE
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State | FL
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Zip | 33315-1509
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Country | US
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Telephone | 954-763-2300
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Fax |
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Provider Business Mailing Address
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Address Line | 1420 SW 3RD AVE
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City | FORT LAUDERDALE
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State | FL
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Zip | 33315-1509
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Country | US
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Telephone | 954-763-2300
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Fax |
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Authorized Official
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Title or Position | CHEIF EXECUTIVE OFFICER
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Name | RONALD S MALEC
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Credential |
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Telephone | 954-763-2300
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number | 1706AD576001
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License Number State | FL
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