1316328750 NPI number — KEYSTONE COMMUNITY LIVING, INC.

Table of content: MS. PATTY JONTZA ANEZ LMT (NPI 1356468185)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1316328750 NPI number — KEYSTONE COMMUNITY LIVING, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
KEYSTONE COMMUNITY LIVING, INC.
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:
1316328750
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/30/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
154 FRONT ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SOUTH PLAINFIELD
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07080-3402
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
908-757-1080
Provider Business Mailing Address Fax Number:
908-755-6810

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
239 LAWRENCE AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NORTH PLAINFIELD
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07063-1622
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
908-757-1080
Provider Business Practice Location Address Fax Number:
908-755-6810
Provider Enumeration Date:
06/11/2015

Additional Information

Authorized Official

Authorized Official Last Name:
FANTUZZI
Authorized Official First Name:
RAY
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
908-757-1080

Provider Taxonomy Codes

  • Taxonomy code: 320900000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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