Organization
KEYSTONE SUPPORT SERVICES LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
REGINA SHERMAN (OWNER/ OPERATOR)
(352) 658-1016
Entity
Organization
Contact information
Practice address
10135 GATE PKWY N APT 1516, JACKSONVILLE, FL 32246-8267
(954) 224-8216
Mailing address
10135 GATE PKWY N APT 1516, JACKSONVILLE, FL 32246-8267
(954) 224-8216
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
—
—
261QD1600X
Developmental Disabilities Clinic/Center
Primary
—
—
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
—
—
Other
Enumeration date
12/14/2020
Last updated
12/15/2020
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