MEDICARE: KEYSTONE ADVANCED BEHAVIORAL HEALTHCARE

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	364SP0809X	Adult Psychiatric/Mental Health Clinical Nurse Specialist	CNS000026	PA

General Provider Information

NPI Number	:	1184969271
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KEYSTONE ADVANCED BEHAVIORAL HEALTHCARE

Provider Business Mailing Address
First Line	:	12300 PERRY HIGHWAY
Second Line	:	SUITE 204
City	:	WEXFORD
State	:	PA
Zip	:	15090-7612
Country	:	US
Telephone Number	:	724-719-2303
Fax Number	:	724-719-2303

Provider Business Practice Location Address
First Line	:	12300 PERRY HIGHWAY
Second Line	:	SUITE 204
City	:	WEXFORD
State	:	PA
Zip	:	15090-7612
Country	:	US
Telephone Number	:	724-719-2303
Fax Number	:	724-719-2303

Authorized Official
Title or Position	:	OWNER
Name	:	DR. WENDY NUSS ZUBENKO
Credential	:	EDD, MSN, PMHCNS-BC
Telephone Number	:	724-719-2303

Provider Enumeration Date	:	11/30/2012
Last Update Date	:	07/16/2019

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