Provider Demographics
NPI:1194260943
Name:KEYSTONE RURAL HEALTH CONSORTIA, INC
Entity type:Organization
Organization Name:KEYSTONE RURAL HEALTH CONSORTIA, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:KRISTIE
Authorized Official - Middle Name:
Authorized Official - Last Name:BENNARDI
Authorized Official - Suffix:
Authorized Official - Credentials:CEO
Authorized Official - Phone:814-486-1115
Mailing Address - Street 1:90 E 2ND ST
Mailing Address - Street 2:P.O. BOX 270
Mailing Address - City:EMPORIUM
Mailing Address - State:PA
Mailing Address - Zip Code:15834-1302
Mailing Address - Country:US
Mailing Address - Phone:814-486-1115
Mailing Address - Fax:
Practice Address - Street 1:49 RIDGMONT DR STE 1
Practice Address - Street 2:
Practice Address - City:RIDGWAY
Practice Address - State:PA
Practice Address - Zip Code:15853-9700
Practice Address - Country:US
Practice Address - Phone:814-245-2119
Practice Address - Fax:814-245-2122
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-04
Last Update Date:2020-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)