Provider Demographics
NPI:1568232072
Name:KEYANNA PROFESSIONAL SERVICES, LTD COMPANY
Entity type:Organization
Organization Name:KEYANNA PROFESSIONAL SERVICES, LTD COMPANY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:KEYANNA
Authorized Official - Middle Name:
Authorized Official - Last Name:MOSS
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:470-553-8500
Mailing Address - Street 1:PO BOX 112
Mailing Address - Street 2:
Mailing Address - City:SPARTA
Mailing Address - State:GA
Mailing Address - Zip Code:31087-0112
Mailing Address - Country:US
Mailing Address - Phone:470-553-8500
Mailing Address - Fax:
Practice Address - Street 1:1160 CLEVELAND RD
Practice Address - Street 2:
Practice Address - City:FORT VALLEY
Practice Address - State:GA
Practice Address - Zip Code:31030-9654
Practice Address - Country:US
Practice Address - Phone:470-550-8882
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-05
Last Update Date:2025-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171W00000XOther Service ProvidersContractorGroup - Multi-Specialty
No174200000XOther Service ProvidersMeals
No253Z00000XAgenciesIn Home Supportive Care
No385H00000XRespite Care FacilityRespite Care
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
No177F00000XOther Service ProvidersLodging
No342000000XTransportation ServicesTransportation Network Company
No335G00000XSuppliersMedical Foods Supplier
No347C00000XTransportation ServicesPrivate Vehicle
No332U00000XSuppliersHome Delivered Meals
No343800000XTransportation ServicesSecured Medical Transport (VAN)