Keywest Center Inc.

Primary specialty

Intellectual Disabilities Intermediate Care FacilityTaxonomy code 315P00000X

License

MHL-032-049 Issued in NC

Legal business name

KEYWEST CENTER INC.

Practice address

1722 Athens Ave.
Durham, NC 27707-4312

Phone

(919) 682-9392

Fax

(919) 683-1774

NPI assigned

Jan 16, 2007

Organization subpart

No

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

Authorized official

Name

Mr. Tony Bullock

Title

Administrator

Phone

(919) 682-9392

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Intermediate care facility for individuals with intellectual disabilities certification: CCN 34G143

Legal name

KEYWEST CENTER

Certification status

Active

Provider type (POS)

Intermediate care facility for individuals with intellectual disabilities

Participating since

May 22, 1990

Last certification

Dec 31, 2024

Beds

6

Ownership / control type

Private (proprietary)

Facility address

1722 Athens Avenue
Durham, NC 27707

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

{
    "created_epoch": "1168905600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1356492425",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1722 ATHENS AVE.",
            "city": "DURHAM",
            "state": "NC",
            "postal_code": "277074312",
            "telephone_number": "919-682-9392",
            "fax_number": "919-683-1774"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1722 ATHENS AVE.",
            "city": "DURHAM",
            "state": "NC",
            "postal_code": "277074312",
            "telephone_number": "919-682-9392",
            "fax_number": "919-683-1774"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KEYWEST CENTER INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-16",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "BULLOCK",
        "authorized_official_first_name": "TONY",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "919-682-9392",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "315P00000X",
            "taxonomy_group": "",
            "desc": "Intermediate Care Facility, Intellectual Disabilities",
            "state": "NC",
            "license": "MHL-032-049",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3406548",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• James W Key, MA NCC LCMHC
• Kristin Marie Key, MA
• Megan Key, LCSWA
• Abigail B Keys, PSYD
• Abby Keyton, P.T.
• Kerestina Khalil, MD
• Hardarshan Kaur Khalsa, LPC
• Aftab Khan, OD
• Ahmed Khan, M.D.
• Asif Alam Khan, MD

• Intellectual Disabilities Intermediate Care Facility in Durham, NC
• Providers in Durham, NC by specialty
• Intellectual Disabilities Intermediate Care Facility in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.