Provider Demographics
NPI:1215451927
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:RN
Authorized Official - Phone:814-486-1115
Mailing Address - Street 1:PO BOX 270
Mailing Address - Street 2:
Mailing Address - City:EMPORIUM
Mailing Address - State:PA
Mailing Address - Zip Code:15834-0270
Mailing Address - Country:US
Mailing Address - Phone:814-486-1115
Mailing Address - Fax:814-486-1204
Practice Address - Street 1:90 E 2ND ST
Practice Address - Street 2:
Practice Address - City:EMPORIUM
Practice Address - State:PA
Practice Address - Zip Code:15834-1302
Practice Address - Country:US
Practice Address - Phone:814-486-1115
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:KEYSTONE RURAL HEALTH CONSORTIA, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-08-03
Last Update Date:2024-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
No1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty