Organization
KEYSTONE RESIDENTIAL LIVING LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JACQUELINE COLEMAN (OFFICE MANAGER)
(571) 243-8164
Entity
Organization
Contact information
Practice address
4528 FORESTBURG LN, TRIANGLE, VA 22172-1705
(571) 243-8164
Mailing address
4528 FORESTBURG LN, TRIANGLE, VA 22172-1705
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
—
—
320800000X
Mental Illness Community Based Residential Treatment Facility
—
—
Other
Enumeration date
11/19/2024
Last updated
11/19/2024
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