Provider Demographics
NPI:1699919084
Name:KEYSTONE HEALTHCARE INC
Entity type:Organization
Organization Name:KEYSTONE HEALTHCARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DICKSON
Authorized Official - Middle Name:
Authorized Official - Last Name:ALAO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-262-9501
Mailing Address - Street 1:777 S CENTRAL EXPY
Mailing Address - Street 2:STE I - H
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75080-7411
Mailing Address - Country:US
Mailing Address - Phone:972-262-9501
Mailing Address - Fax:972-767-4004
Practice Address - Street 1:777 S CENTRAL EXPY
Practice Address - Street 2:STE I - H
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75080-7411
Practice Address - Country:US
Practice Address - Phone:972-262-9501
Practice Address - Fax:972-767-4004
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-29
Last Update Date:2016-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX012782251E00000X, 251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251E00000XAgenciesHome HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX292186801Medicaid
TX747319Medicare Oscar/Certification