NPIMap

Organization Active NPI

Keystonecare Home Health LLC

  • Home Health Agency
  • Wyndmoor, PA
National Provider Identifier
1861630030
Registry record updated May 11, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Home Health AgencyTaxonomy code 251E00000X
Legal business name
KEYSTONECARE HOME HEALTH LLC
Practice address
8765 Stenton Ave
Wyndmoor, PA 19038-8317
Phone
(215) 836-2440
Fax
(215) 836-2448
NPI assigned
Jan 27, 2009
Last updated
May 11, 2012By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 11, 2012

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

Authorized official

Name
Gail A Inderwies, RN,BSN,MBA
Title
Administrator
Phone
(215) 836-2440

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Home Health Agency 251E00000X NU Primary

Addresses

Primary practice location

8765 Stenton Ave
Wyndmoor, PA 19038-8317

Mailing address

8765 Stenton Avenue
Wyndmoor, PA 19038
Phone (215) 836-2440

Other identifiers 1

IdentifierTypeStateIssuer
1022901810001MedicaidPA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20090209000415 PA Part A Provider - Home Health Agency 8325103302 Practice locations: Wyndmoor, PA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1861630030. Details of each certification follow.

Home health agency certification: CCN 398100

Legal name
KEYSTONECARE HOME HEALTH LLC
Doing business as
KEYSTONECARE HOME HEALTH, LLC
Certification status
Active
Provider type (POS)
Home health agency
Participating since
Apr 17, 2009
Last certification
Dec 14, 2020
Ownership / control type
Proprietary
Organization structure
LLCNon-profit
Incorporated
Jan 27, 2009 in PA
Enrollment address
8765 Stenton Ave
Wyndmoor, PA 19038-8317
HHA Branch

Care Compare: Home health agency

Medicare Care Compare
Listed as
Keystonecare Home Health, LLCCCN 398100 · All quality measures
Overall star rating
4.5 of 5
Ownership
Proprietary
Certified
Apr 17, 2009
Medicare certification status
ActiveFrom the Provider of Services file
Services
Nursing, Medical social, Home health aide, Physical therapy, Speech pathology, Occupational therapy

National Provider Directory

National Provider Directory

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Locations

8765 Stenton Ave
Wyndmoor, PA 19038
Phone (215) 836-2440

Ownership & related parties

All disclosed owners & managing parties 6

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Peter Amuso Individual Corporate Director Jan 1, 2008
Eric Rolin Individual Corporate Director Jan 1, 2015
June M Fry Individual Corporate Director Mar 1, 2019
Keystonecare Organization, Wyndmoor, PA Non-profit 5% Or Greater Direct Ownership Interest Jan 1, 2011 100%
Operational/Managerial Control Jan 1, 2011 100%
Gail a Inderwies Individual Corporate OfficerExecutive Director and Board Member Oct 1, 2009
W-2 Managing EmployeeExecutive Director and Board Member Jan 19, 2009
Connie M. Bolig Individual Corporate Director Jan 1, 2005

Owners & managing parties with NPI records 1

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

Practitioners & affiliated clinicians

Affiliated clinicians 22

Clinicians who list this facility as an affiliation in Medicare Care Compare.

View all 22

NPI Registry JSON

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

{
    "created_epoch": "1233014400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1336694400000",
    "number": "1861630030",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8765 STENTON AVENUE",
            "city": "WYNDMOOR",
            "state": "PA",
            "postal_code": "19038",
            "telephone_number": "215-836-2440",
            "fax_number": "215-836-2448"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8765 STENTON AVE",
            "city": "WYNDMOOR",
            "state": "PA",
            "postal_code": "190388317",
            "telephone_number": "215-836-2440",
            "fax_number": "215-836-2448"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KEYSTONECARE HOME HEALTH LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-01-27",
        "last_updated": "2012-05-11",
        "status": "A",
        "authorized_official_last_name": "INDERWIES",
        "authorized_official_first_name": "GAIL",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "215-836-2440",
        "authorized_official_credential": "RN,BSN,MBA"
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1022901810001",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Wyndmoor, PA

Sources for this page

Verify at the official NPI Registry.