Provider Demographics
NPI:1063539054
Name:KEYSTONE SERVICES, INC DBA
Entity type:Organization
Organization Name:KEYSTONE SERVICES, INC DBA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PAYROLL CLERK
Authorized Official - Prefix:MS
Authorized Official - First Name:SHERRY
Authorized Official - Middle Name:TENNANT
Authorized Official - Last Name:FISHER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:502-540-1482
Mailing Address - Street 1:2210 MEADOW DR
Mailing Address - Street 2:SUITE 4
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40218-1323
Mailing Address - Country:US
Mailing Address - Phone:502-540-1482
Mailing Address - Fax:502-540-5626
Practice Address - Street 1:2210 MEADOW DR
Practice Address - Street 2:SUITE 4
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40218-1323
Practice Address - Country:US
Practice Address - Phone:502-540-1482
Practice Address - Fax:502-540-5626
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes372600000XNursing Service Related ProvidersAdult CompanionGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY33000753Medicaid