Healthcare Provider Details

I. General information

NPI: 1568076578
Provider Name (Legal Business Name): KEYSTONE PLACE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/08/2020
Last Update Date: 09/08/2020
Certification Date: 09/08/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6126 ROCKWELL DR NE
CEDAR RAPIDS IA
52402-4781
US

IV. Provider business mailing address

3965 AIRPORT DR
INDIANAPOLIS IN
46254-5845
US

V. Phone/Fax

Practice location:
  • Phone: 319-593-9500
  • Fax: 319-393-9501
Mailing address:
  • Phone: 317-409-9252
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174200000X
TaxonomyMeals Provider
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code177F00000X
TaxonomyLodging Provider
License Number
License Number State

VIII. Authorized Official

Name: BRENDA ARMSTRONG
Title or Position: GENERAL COUNSEL
Credential:
Phone: 317-409-9252