Provider Demographics
NPI:1881128098
Name:KEYSTONE TREATMENT
Entity type:Organization
Organization Name:KEYSTONE TREATMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR/SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:TAMARA
Authorized Official - Middle Name:
Authorized Official - Last Name:BAGHDASSARIAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:626-429-3127
Mailing Address - Street 1:6609 PEACH AVE
Mailing Address - Street 2:
Mailing Address - City:VAN NUYS
Mailing Address - State:CA
Mailing Address - Zip Code:91406-6321
Mailing Address - Country:US
Mailing Address - Phone:626-429-3127
Mailing Address - Fax:
Practice Address - Street 1:3151 CAHUENGA BLVD W
Practice Address - Street 2:SUITE 335
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90068-1768
Practice Address - Country:US
Practice Address - Phone:626-429-3127
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-13
Last Update Date:2017-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health