Organization
KEYWEST CENTER INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. TONY BULLOCK (ADMINISTRATOR)
(919) 682-9392
Entity
Organization
Contact information
Practice address
1722 ATHENS AVE., DURHAM, NC 27707-4312
(919) 682-9392
(919) 683-1774
Mailing address
1722 ATHENS AVE., DURHAM, NC 27707-4312
(919) 682-9392
(919) 683-1774
Taxonomy
Speciality
Code
Description
License number
State
315P00000X
Intellectual Disabilities Intermediate Care Facility
Primary
MHL-032-049
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3406548
—
NC
Enumeration date
01/16/2007
Last updated
08/22/2020
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