MEDICARE: KEYS 2 INDEPENDENT LIVING, LLC

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	374U00000X	Home Health Aide

General Provider Information

NPI Number	:	1568067601
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KEYS 2 INDEPENDENT LIVING, LLC

Provider Business Mailing Address
First Line	:	5810 SOUTHWYCK BLVD STE 101A
Second Line	:
City	:	TOLEDO
State	:	OH
Zip	:	43614-1518
Country	:	US
Telephone Number	:	567-315-8000
Fax Number	:

Provider Business Practice Location Address
First Line	:	5810 SOUTHWYCK BLVD STE 101A
Second Line	:
City	:	TOLEDO
State	:	OH
Zip	:	43614-1518
Country	:	US
Telephone Number	:	567-315-8000
Fax Number	:

Authorized Official
Title or Position	:	OWNER/DIRECTOR
Name	:	ASJA LAJOI WYNN
Credential	:
Telephone Number	:	419-902-6988

Provider Enumeration Date	:	12/04/2020
Last Update Date	:	04/29/2021

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