Organization
KEYSTONE HOUSE INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. BARRY MCGOVERN RN MPH (ASSOCIATE EXECUTIVE DIRECTOR)
(203) 956-7816
Entity
Organization
Contact information
Practice address
147 MAIN ST, NORWALK, CT 06851-3709
(203) 956-7816
Mailing address
147 MAIN ST, NORWALK, CT 06851-3709
(203) 956-7816
Taxonomy
Speciality
Code
Description
License number
State
320800000X
Mental Illness Community Based Residential Treatment Facility
Primary
0RLC0016
CT
320800000X
Mental Illness Community Based Residential Treatment Facility
0RLC0022
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
004246428
—
CT
05
—
004246436
—
CT
Enumeration date
08/31/2005
Last updated
01/02/2013
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