MEDICARE: KEYSTONE SERVICES, INC DBA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	372600000X	Adult Companion

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1063539054
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KEYSTONE SERVICES, INC DBA

Provider Business Mailing Address
First Line	:	2210 MEADOW DR
Second Line	:	SUITE 4
City	:	LOUISVILLE
State	:	KY
Zip	:	40218-1323
Country	:	US
Telephone Number	:	502-540-1482
Fax Number	:	502-540-5626

Provider Business Practice Location Address
First Line	:	2210 MEADOW DR
Second Line	:	SUITE 4
City	:	LOUISVILLE
State	:	KY
Zip	:	40218-1323
Country	:	US
Telephone Number	:	502-540-1482
Fax Number	:	502-540-5626

Authorized Official
Title or Position	:	PAYROLL CLERK
Name	:	MS. SHERRY TENNANT FISHER
Credential	:
Telephone Number	:	502-540-1482

Provider Enumeration Date	:	03/23/2007
Last Update Date	:	08/22/2020

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Directions to “KEYSTONE SERVICES, INC DBA ” Practice Location

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