Organization
KEYSTONE CARE, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. CRYSTAL BUSH LISW-CP (ORGANIZER)
(919) 539-8520
Entity
Organization
Contact information
Practice address
285 LA PATOS DR, MYRTLE BEACH, SC 29588-8484
(191) 953-9852
Mailing address
285 LA PATOS DR, MYRTLE BEACH, SC 29588-8484
(191) 953-9852
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
—
—
2084P0800X
Psychiatry Physician
—
—
251S00000X
Community/Behavioral Health Agency
Primary
—
—
261QM1300X
Multi-Specialty Clinic/Center
—
—
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
—
—
Other
Enumeration date
01/02/2019
Last updated
01/02/2019
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