Provider Demographics
NPI:1134505092
Name:HIGHLAND PARK OPS LLC
Entity Type:Organization
Organization Name:HIGHLAND PARK OPS LLC
Other - Org Name:KEYSTONE HIGHLAND
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:
Authorized Official - Last Name:NOVACZYK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:952-241-8204
Mailing Address - Street 1:7625 GOLDEN TRIANGLE DR
Mailing Address - Street 2:SUITE T
Mailing Address - City:EDEN PRAIRIE
Mailing Address - State:MN
Mailing Address - Zip Code:55344-3710
Mailing Address - Country:US
Mailing Address - Phone:952-241-8202
Mailing Address - Fax:
Practice Address - Street 1:750 MISSISSIPPI RIVER BLVD S
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55116-1006
Practice Address - Country:US
Practice Address - Phone:651-698-1111
Practice Address - Fax:651-698-8688
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-03
Last Update Date:2015-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility