Keystone Family Support, Inc.

Primary specialty

Emotionally Disturbed Childrens' Residential Treatment FacilityTaxonomy code 322D00000X

License

12525 Issued in UT

Legal business name

KEYSTONE FAMILY SUPPORT, INC.

Practice address

2558 Valley View Dr
Layton, UT 84040-7654

Phone

(801) 645-6451

NPI assigned

Jul 7, 2015

Last updated

Jul 7, 2015By the provider in NPPES

Organization subpart

Yes

Parent organization

KEYSTONE FAMILY SUPPORT, INC.As reported in NPPES

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Ms. Holly Stock, TEACHER

Title

President/Director

Phone

(801) 645-6451

Specialties & licenses 1

Addresses

Part of

Keystone Family Support Inc

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1436227200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1436227200000",
    "number": "1033592290",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "195 E 550 N",
            "city": "FARMINGTON",
            "state": "UT",
            "postal_code": "840252522",
            "telephone_number": "801-645-6451"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2558 VALLEY VIEW DR",
            "city": "LAYTON",
            "state": "UT",
            "postal_code": "840407654",
            "telephone_number": "801-645-6451"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KEYSTONE FAMILY SUPPORT, INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "KEYSTONE FAMILY SUPPORT, INC.",
        "enumeration_date": "2015-07-07",
        "last_updated": "2015-07-07",
        "status": "A",
        "authorized_official_last_name": "STOCK",
        "authorized_official_first_name": "HOLLY",
        "authorized_official_title_or_position": "PRESIDENT/DIRECTOR",
        "authorized_official_telephone_number": "801-645-6451",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "TEACHER"
    },
    "taxonomies": [
        {
            "code": "322D00000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Emotionally Disturbed Children",
            "state": "UT",
            "license": "12525",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Brad Mark Kercher, LCSW
• Kennedy Kerr
• Jeremy Kessler, M.D.
• Jack Kettering, MA
• Nicole Keyes
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• Mikel Ray Kilfoyle, RN
• Bonnie Kilgannon

• Emotionally Disturbed Childrens' Residential Treatment Facility in Layton, UT
• Providers in Layton, UT by specialty
• Emotionally Disturbed Childrens' Residential Treatment Facility in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 7, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.