MEDICARE: KEYS 2 HEALING HEARTS 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	320900000X	Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility

General Provider Information

NPI Number	:	1578066445
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KEYS 2 HEALING HEARTS LLC

Provider Business Mailing Address
First Line	:	2710 HULLSMITH DR APT 1403
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77063-4644
Country	:	US
Telephone Number	:	248-747-3423
Fax Number	:

Provider Business Practice Location Address
First Line	:	2710 HULLSMITH DR APT 1403
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77063-4644
Country	:	US
Telephone Number	:	248-747-3423
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	KEAUNDRA RICHARDSON
Credential	:
Telephone Number	:	248-747-3423

Provider Enumeration Date	:	03/16/2018
Last Update Date	:	03/16/2018

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