Provider Demographics
NPI:1710781828
Name:ROSS, KEITH (MHA, CHSP)
Entity type:Individual
Prefix:
First Name:KEITH
Middle Name:
Last Name:ROSS
Suffix:
Gender:M
Credentials:MHA, CHSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:225 PINE ST
Mailing Address - Street 2:
Mailing Address - City:GLENOLDEN
Mailing Address - State:PA
Mailing Address - Zip Code:19036-1005
Mailing Address - Country:US
Mailing Address - Phone:215-602-0594
Mailing Address - Fax:
Practice Address - Street 1:225 PINE ST
Practice Address - Street 2:
Practice Address - City:GLENOLDEN
Practice Address - State:PA
Practice Address - Zip Code:19036-1005
Practice Address - Country:US
Practice Address - Phone:215-602-0594
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-01
Last Update Date:2025-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372600000XNursing Service Related ProvidersAdult Companion
No253Z00000XAgenciesIn Home Supportive Care
No374U00000XNursing Service Related ProvidersHome Health Aide