Organization
KEYS 4 L.I.F.E.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. DERRICK JEROME GREEN SR. BS,QP (C.E.O.)
(910) 817-7422
Entity
Organization
Contact information
Practice address
136 RAIDER RD, ROCKINGHAM, NC 28379-9609
(910) 334-4390
Mailing address
136 RAIDER RD, ROCKINGHAM, NC 28379-9609
(910) 334-4390
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000000
—
NC
Enumeration date
12/05/2012
Last updated
12/05/2012
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