1043561582 NPI number — KEYS TO LIFE HOME HEALTH PARTNERS LLC

Table of content: (NPI 1376286591)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1043561582 NPI number — KEYS TO LIFE HOME HEALTH PARTNERS LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
KEYS TO LIFE HOME HEALTH PARTNERS LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1043561582
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/28/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 103
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DAYTON
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
45401-0103
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
937-409-4430
Provider Business Mailing Address Fax Number:
937-985-5824

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3379 CORTEZ DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DAYTON
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45415-2723
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
937-409-4430
Provider Business Practice Location Address Fax Number:
937-985-5824
Provider Enumeration Date:
09/24/2012

Additional Information

Authorized Official

Authorized Official Last Name:
WILLIAMS
Authorized Official First Name:
PIRA
Authorized Official Middle Name:
ALEXIS
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
937-409-4430

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , with the licence number:  PN125422-IV , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1518272095 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com