Keystone House Inc.

Primary specialty

Mental Illness Community Based Residential Treatment FacilityTaxonomy code 320800000X

License

0RLC0016 Issued in CT

Legal business name

KEYSTONE HOUSE INC.

Practice address

147 Main St
Norwalk, CT 06851-3709

Phone

(203) 956-7816

NPI assigned

Aug 31, 2005

Organization subpart

No

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

Authorized official

Name

Mr. Barry McGovern, RN MPH

Title

Associate Executive Director

Phone

(203) 956-7816

Specialties & licenses 2

Addresses

Other identifiers 2

Locations

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

{
    "created_epoch": "1125446400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1357084800000",
    "number": "1356335798",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "147 MAIN ST",
            "city": "NORWALK",
            "state": "CT",
            "postal_code": "068513709",
            "telephone_number": "203-956-7816"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "147 MAIN ST",
            "city": "NORWALK",
            "state": "CT",
            "postal_code": "068513709",
            "telephone_number": "203-956-7816"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KEYSTONE HOUSE INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-08-31",
        "last_updated": "2013-01-02",
        "status": "A",
        "authorized_official_last_name": "MCGOVERN",
        "authorized_official_first_name": "BARRY",
        "authorized_official_title_or_position": "ASSOCIATE EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "203-956-7816",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "RN MPH"
    },
    "taxonomies": [
        {
            "code": "320800000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Mental Illness",
            "state": "CT",
            "license": "0RLC0016",
            "primary": true
        },
        {
            "code": "320800000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Mental Illness",
            "state": "CT",
            "license": "0RLC0022",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "004246428",
            "state": "CT"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "004246436",
            "state": "CT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Mental Illness Community Based Residential Treatment Facility in Norwalk, CT
• Providers in Norwalk, CT by specialty
• Mental Illness Community Based Residential Treatment Facility in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 2, 2013; 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.