Healthcare Provider Details

I. General information

NPI: 1023312386
Provider Name (Legal Business Name): KEYSTYLE LIVING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/30/2010
Last Update Date: 12/30/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

512 BAYSHORE RD
NOKOMIS FL
34275-1912
US

IV. Provider business mailing address

512 BAYSHORE RD
NOKOMIS FL
34275-1912
US

V. Phone/Fax

Practice location:
  • Phone: 941-484-1222
  • Fax: 941-485-6808
Mailing address:
  • Phone: 941-484-1222
  • Fax: 941-485-6808

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License NumberAL11852
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code3104A0630X
TaxonomyAssisted Living Facility (Behavioral Disturbances)
License NumberAL11852
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code310500000X
TaxonomyMental Illness Intermediate Care Facility
License NumberAL11852
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code311500000X
TaxonomyAlzheimer Center (Dementia Center)
License NumberAL11852
License Number StateFL
# 5
Primary TaxonomyN
Taxonomy Code311Z00000X
TaxonomyCustodial Care Facility
License NumberAL11852
License Number StateFL
# 6
Primary TaxonomyN
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License NumberAL11852
License Number StateFL
# 7
Primary TaxonomyN
Taxonomy Code313M00000X
TaxonomyNursing Facility/Intermediate Care Facility
License NumberAL11852
License Number StateFL
# 8
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License NumberAL11852
License Number StateFL

VIII. Authorized Official

Name: MRS. MONICA ELIZABETH DOWHAN
Title or Position: OWNER/ADMINISTRATOR
Credential:
Phone: 941-484-1222