MEDICARE: KEYS DEVELOPMENT TA 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	324500000X	Substance Abuse Rehabilitation Facility

General Provider Information

NPI Number	:	1942188073
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KEYS DEVELOPMENT TA LLC

Provider Business Mailing Address
First Line	:	7501 LIBERTY RD STE ABFG&L
Second Line	:
City	:	GWYNN OAK
State	:	MD
Zip	:	21207-3870
Country	:	US
Telephone Number	:	443-429-2536
Fax Number	:	443-429-2168

Provider Business Practice Location Address
First Line	:	717 E 23RD ST
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21218-5443
Country	:	US
Telephone Number	:	443-429-2536
Fax Number	:	443-429-2168

Authorized Official
Title or Position	:	DIRECTOR OF OPERATIONS
Name	:	ERIKA TRACEY ROBINSON
Credential	:
Telephone Number	:	443-429-2536

Provider Enumeration Date	:	08/26/2025
Last Update Date	:	09/19/2025

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