Healthcare Provider Details

I. General information

NPI: 1003246000
Provider Name (Legal Business Name): KEYSTONE NURSING CARE CENTER, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/13/2013
Last Update Date: 09/11/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

280 5TH ST SUITE 2
KEYSTONE IA
52249-9533
US

IV. Provider business mailing address

280 5TH ST APT 2
KEYSTONE IA
52249-9533
US

V. Phone/Fax

Practice location:
  • Phone: 319-442-3234
  • Fax: 319-442-3550
Mailing address:
  • Phone: 319-442-3650
  • Fax: 319-442-3550

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code313M00000X
TaxonomyNursing Facility/Intermediate Care Facility
License NumberN263
License Number StateIA

VIII. Authorized Official

Name: MS. TRACY LYNN HANSON
Title or Position: ADMINISTRATOR
Credential: R. N.
Phone: 319-442-3234