Provider Demographics
NPI:1003246000
Name:KEYSTONE NURSING CARE CENTER, INC
Entity Type:Organization
Organization Name:KEYSTONE NURSING CARE CENTER, INC
Other - Org Name:KEYSTONE HOME HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:TRACY
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:HANSON
Authorized Official - Suffix:
Authorized Official - Credentials:R N
Authorized Official - Phone:319-442-3234
Mailing Address - Street 1:280 5TH ST APT 2
Mailing Address - Street 2:
Mailing Address - City:KEYSTONE
Mailing Address - State:IA
Mailing Address - Zip Code:52249-9533
Mailing Address - Country:US
Mailing Address - Phone:319-442-3650
Mailing Address - Fax:319-442-3550
Practice Address - Street 1:280 5TH ST
Practice Address - Street 2:SUITE 2
Practice Address - City:KEYSTONE
Practice Address - State:IA
Practice Address - Zip Code:52249-9533
Practice Address - Country:US
Practice Address - Phone:319-442-3234
Practice Address - Fax:319-442-3550
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-13
Last Update Date:2018-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251E00000X
IAN263313M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0802140Medicaid