Organization
KEYSTONE WSNC, LLC
Active
Other names
Old Vineyard Behavioral Health Services
Organization subpart
No
Provider details
NPI number
Authorized official
STEVE FILTON (SR VP CFO)
(610) 768-3300
Entity
Organization
Contact information
Practice address
3637 OLD VINEYARD RD, WINSTON SALEM, NC 27104-4842
(336) 794-3550
(336) 794-3545
Mailing address
3637 OLD VINEYARD RD, WINSTON SALEM, NC 27104-4842
(336) 794-3550
(336) 794-3545
Taxonomy
Speciality
Code
Description
License number
State
283Q00000X
Psychiatric Hospital
Primary
MHH0188
NC
323P00000X
Psychiatric Residential Treatment Facility
MHH0188
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3404007
—
NC
05
—
3404520
—
NC
Enumeration date
07/04/2006
Last updated
12/19/2014
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