Keys 4 L.I.F.E.

Primary specialty

Community/Behavioral Health AgencyTaxonomy code 251S00000X

Legal business name

KEYS 4 L.I.F.E.

Practice address

136 Raider Rd
Rockingham, NC 28379-9609

Phone

(910) 334-4390

NPI assigned

Dec 5, 2012

Organization subpart

No

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

Authorized official

Name

Mr. Derrick Jerome Green Sr., BS,QP

Title

C.E.O.

Phone

(910) 817-7422

Specialties & licenses 1

Addresses

Other identifiers 1

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

{
    "created_epoch": "1354665600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1354665600000",
    "number": "1649515412",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "136 RAIDER RD",
            "city": "ROCKINGHAM",
            "state": "NC",
            "postal_code": "283799609",
            "telephone_number": "910-334-4390"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "136 RAIDER RD",
            "city": "ROCKINGHAM",
            "state": "NC",
            "postal_code": "283799609",
            "telephone_number": "910-334-4390"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KEYS 4 L.I.F.E.",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-12-05",
        "last_updated": "2012-12-05",
        "status": "A",
        "authorized_official_last_name": "GREEN",
        "authorized_official_first_name": "DERRICK",
        "authorized_official_middle_name": "JEROME",
        "authorized_official_title_or_position": "C.E.O.",
        "authorized_official_telephone_number": "910-817-7422",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_name_suffix": "Sr.",
        "authorized_official_credential": "BS,QP"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000000",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Rosette Joseph, PMHNP-BC
• Robin Lupton Kapp, LPA
• Karolina Area Transportation Services, LLC
• Lucy Kenya
• Jeffery Justin Kern, PA-C
• Shamsul Alam Khan, MD
• Parviz Khoshnevis, M.D.
• Connie C Kirkley, PNP
• Sharon Maxine Knotts, NP
• Labcheck Diagnostics LLC

• Community/Behavioral Health Agency in Rockingham, NC
• Providers in Rockingham, NC by specialty
• Community/Behavioral Health Agency in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 5, 2012; 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.