KEYSTONE INDEPENDENT LIVING (NPI# 1689913196) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1689913196 |
| Entity Type | Organization |
| Organization Name | KEYSTONE INDEPENDENT LIVING |
| Practice Address |
202 Boulevard Ave Peckville PA 18452-1002 |
| Mailing Address |
100 Abington Executive Park Suite B Clarks Summit PA 18411-2260 |
| Practice Telephone | 5703074067 |
| Mailing Telephone | 5707028000 |
| Enumeration Date | 2013-02-04 |
| Last Update Date | 2013-02-04 |
| Authorized Official Name | MR. ROBERT FLEESE (PRESIDENT/OWNER) |
| Authorized Official Telephone | 5707028104 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 311ZA0620X |
Custodial Care Facility Specialization: Adult Care Home |
226650 | PA | Nursing & Custodial Care Facilities |
| Street Address |
202 BOULEVARD AVE |
| City | PECKVILLE |
| State | PA |
| Zip Code | 18452-1002 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1275718363 | Eugene Marchegiani Jr. | Chiropractor | 440 Keystone Ave, Peckville, PA 18452 | 2008-01-08 |
| 1598745499 | Anthony William Freda | Internal Medicine | 320 Keystone Ave, Peckville, PA 18452 | 2006-01-18 |
| 1396140505 | William John Antognoli | Pathology | 613 Main Street, Peckville, PA 18452 | 2014-10-30 |
| 1104042043 | Joanne Ryczak | Dietitian, Registered | 1400 Main St, Mid Valley Hospital, Peckville, PA 18452 | 2007-04-18 |
| 1083714331 | Thrift Drug Inc | Durable Medical Equipment & Medical Supplies | 1425 Main Street, Peckville, PA 18452 | 2006-09-25 |
| 1457463275 | Cynthia G Charnetski | Optometrist | 1582 Main St, Peckville, PA 18452 | 2006-08-31 |
| 1417963844 | Angela Michelle Plominski | Specialist/Technologist | 1333 Main St, Peckville, PA 18452 | 2006-07-31 |
| 1396253183 | Tom Horeis | Pharmacist | 3 Circle Dr, Peckville, PA 18452-1003 | 2018-01-16 |
| 1609473206 | Maura Christine Merli | Nurse Practitioner | 106 Hospital St, Peckville, PA 18452-1108 | 2020-10-06 |
| 1770988693 | Christina Lukowski | Registered Nurse | 754 Crystal St, Peckville, PA 18452-1214 | 2014-11-04 |
| Find all providers in zip 18452 | ||||
| Taxonomy Code | 311ZA0620X |
| Grouping | Nursing & Custodial Care Facilities |
| Classification | Custodial Care Facility |
| Specialization | Adult Care Home |
| A custodial care facility providing supportive and personal care services to disabled and/or elderly individuals who cannot function independently in most areas of activity and need assistance and monitoring to enable them to remain in a home like environment. |
| Notes: [7/1/2003: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1841837218 | Felix Hernandez | Custodial Care Facility | 814 Saint Paul St, Lewisburg, PA 17837-1210 | 2019-12-04 |
| 1811483084 | Silvercare Personal Care LLC | Custodial Care Facility | 34 Copley Rd, Upper Darby, PA 19082-2512 | 2018-07-10 |
| 1265963391 | Sunil Senior Care LLC | Custodial Care Facility | 220 E Chelten Ave, Philadelphia, PA 19144 | 2017-03-21 |
| 1295275519 | Nonprofit Development Corporation | Custodial Care Facility | 921 Grant Ave, East Butler, PA 16029 | 2017-03-06 |
| 1164875696 | White Lily Home Care Inc | Custodial Care Facility | 4915 Wynnefield Avenue, 1af, Wynnefield Heights, PA 19131 | 2016-07-20 |
| 1043661341 | Xzavier Hunter | Custodial Care Facility | 7007 York Rd, Abbottstown, PA 17301-9774 | 2016-06-28 |
| 1801292990 | Alpa Care Concepts | Custodial Care Facility | 6649 Woodland Ave, Philadelphia, PA 19142-1621 | 2014-11-17 |
| 1376971135 | Pocono Tranquil Gardens, LLC | Custodial Care Facility | 329 E Brown St, East Stroudsburg, PA 18301-3014 | 2013-10-14 |
| 1205273943 | Golden Age Care LLC | Custodial Care Facility | 716 Red Lion Rd, Philadelphia, PA 19115-1307 | 2013-06-03 |
| 1801134648 | Just One Nurse | Custodial Care Facility | 5425 Wynnefield Ave, Philadelphia, PA 19131-1323 | 2013-01-29 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.