NPIMap

Organization Active NPI

Keystone WSNC, LLC

Doing business as Old Vineyard Behavioral Health Services

  • Psychiatric Hospital
  • Winston Salem, NC
National Provider Identifier
1922038082
Registry record updated Dec 19, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric HospitalTaxonomy code 283Q00000X
License
MHH0188 Issued in NC
Legal business name
KEYSTONE WSNC, LLC
Doing business as
Old Vineyard Behavioral Health Services
Practice address
3637 Old Vineyard Rd
Winston Salem, NC 27104-4842
Phone
(336) 794-3550
Fax
(336) 794-3545
NPI assigned
Jul 4, 2006
Last updated
Dec 19, 2014By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 19, 2014

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

Authorized official

Name
Steve Filton
Title
Sr VP Cfo
Phone
(610) 768-3300

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric Hospital 283Q00000X MHH0188 NC Primary
Psychiatric Residential Treatment Facility 323P00000X MHH0188 NC

Addresses

Primary practice location

3637 Old Vineyard Rd
Winston Salem, NC 27104-4842

Mailing address

3637 Old Vineyard Rd
Winston Salem, NC 27104-4842
Phone (336) 794-3550

Other identifiers 2

IdentifierTypeStateIssuer
3404007MedicaidNC
3404520MedicaidNC

Other names 1

  • Old Vineyard Behavioral Health Services Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20060911000385 NC Part A Provider - Hospital 2567466386 Practice locations: Winston Salem, NC

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1922038082. Details of each certification follow.

Hospital certification: CCN 344007

Legal name
KEYSTONE WSNC LLC
Doing business as
OLD VINEYARD BEHAVIORAL HEALTH SERVICES
Certification status
Active
Provider type (POS)
Hospital – Psychiatric
Participating since
Dec 20, 2006
Last certification
Jun 22, 2016
Beds
104
Ownership / control type
Private (for profit)
Organization structure
LLCProprietary
Incorporated
Nov 30, 2004 in NC
Enrollment address
3637 Old Vineyard Rd
Winston Salem, NC 27104-4842
Other Hospital Practice Location
Hospital subgroups
Psychiatric

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Care Compare: Hospital

Medicare Care Compare
Listed as
Old Vineyard Youth ServicesCCN 344007 · All quality measures
Type
Psychiatric
Ownership
Proprietary
Medicare certification status
ActiveFrom the Provider of Services file
Emergency services
No

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
34D0983708Old Vineyard Behavioral Health Services3637 Old Vineyard Rd, Winston-Salem, NC 27104Certificate of waiverFeb 28, 2027

National Provider Directory

National Provider Directory
Tax ID family
Keystone WSNC LLC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Ownership & related parties

All disclosed owners & managing parties 15

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

NameRoleSinceShare
George H Brunner Individual Corporate OfficerAssistant Secretary Aug 14, 2006 100%
George D Keaton Individual Contracted Managing EmployeeCfo Group May 5, 2025
Corporate OfficerCfo Group May 5, 2025
Katharine M Lyver Individual Corporate OfficerAssistant Treasurer Jan 1, 2024 100%
Matthew D Klein Individual Corporate OfficerSecretary Oct 1, 2010 100%
Keys Group Holdings, LLC Organization, King of Prussia, PA LLC, Owned by another organization or individual 5% Or Greater Indirect Ownership Interest Aug 14, 2006 100%
Thomas M Day Individual Corporate OfficerPresident - BH Jul 20, 2021 100%
Corporate DirectorPresident - BH Jul 20, 2021 33.3%
Steve Filton Individual Corporate OfficerVice President Aug 14, 2006 100%
Corporate DirectorVice President Aug 14, 2006 33.3%
Operational/Managerial ControlVice President Aug 14, 2006 100%
Kelly S Thacker Individual Contracted Managing EmployeeCeo Jan 1, 2022
Corporate OfficerCeo Jan 1, 2022
Cheryl K Ramagano Individual Corporate OfficerTreasurer Aug 14, 2006 100%
Operational/Managerial ControlTreasurer Aug 14, 2006 100%
Universal Health Services Inc Organization, King of Prussia, PA Corporation, For-profit, Owned by another organization or individual 5% Or Greater Indirect Ownership Interest Aug 14, 2006 100%
James M Coleman Individual Contracted Managing EmployeeSenior Reimbursement Manager Aug 14, 2006 50%
Keystone Education and Youth Services LLC Organization, King of Prussia, PA LLC, Owned by another organization or individual 5% Or Greater Direct Ownership Interest Aug 14, 2006 100%
Uhs Children Services Inc Organization, King of Prussia, PA Corporation, Owned by another organization or individual 5% Or Greater Indirect Ownership Interest Aug 14, 2006 100%
Uhs of Delaware Inc Organization, King of Prussia, PA Corporation, Management services company, Chain home office Operational/Managerial Control Aug 14, 2006 100%
Alan B Miller Individual 5% Or Greater Indirect Ownership Interest Jan 1, 2021 85%

Facilities with the same owner 172

Facilities that share an organizational owner with 5% or greater ownership or operational control.

View all 172

Practitioners & affiliated clinicians

Practitioners 8

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1151971200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1418947200000",
    "number": "1922038082",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3637 OLD VINEYARD RD",
            "city": "WINSTON SALEM",
            "state": "NC",
            "postal_code": "271044842",
            "telephone_number": "336-794-3550",
            "fax_number": "336-794-3545"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3637 OLD VINEYARD RD",
            "city": "WINSTON SALEM",
            "state": "NC",
            "postal_code": "271044842",
            "telephone_number": "336-794-3550",
            "fax_number": "336-794-3545"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KEYSTONE WSNC, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-04",
        "last_updated": "2014-12-19",
        "status": "A",
        "authorized_official_last_name": "FILTON",
        "authorized_official_first_name": "STEVE",
        "authorized_official_title_or_position": "SR VP CFO",
        "authorized_official_telephone_number": "610-768-3300"
    },
    "taxonomies": [
        {
            "code": "283Q00000X",
            "taxonomy_group": "",
            "desc": "Psychiatric Hospital",
            "state": "NC",
            "license": "MHH0188",
            "primary": true
        },
        {
            "code": "323P00000X",
            "taxonomy_group": "",
            "desc": "Psychiatric Residential Treatment Facility",
            "state": "NC",
            "license": "MHH0188",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3404007",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3404520",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Old Vineyard Behavioral Health Services",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Winston Salem, NC

Sources for this page

Verify at the official NPI Registry.