Provider Demographics
NPI:1114077666
Name:KEYSTONE HEALTHCARE & REHABILITATION SERVICES INC
Entity type:Organization
Organization Name:KEYSTONE HEALTHCARE & REHABILITATION SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:DANIEL
Authorized Official - Last Name:SPARKS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:727-796-5478
Mailing Address - Street 1:2040 NE COACHMAN RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33765-2600
Mailing Address - Country:US
Mailing Address - Phone:727-796-5478
Mailing Address - Fax:727-796-5635
Practice Address - Street 1:2040 NE COACHMAN RD
Practice Address - Street 2:SUITE A
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33765-2600
Practice Address - Country:US
Practice Address - Phone:727-796-5478
Practice Address - Fax:727-796-5635
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-10
Last Update Date:2012-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0401XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF)
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL684825Medicare Oscar/Certification