Provider Demographics
NPI:1487027892
Name:KEY CITY ASSISTED LIVING LLC
Entity Type:Organization
Organization Name:KEY CITY ASSISTED LIVING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:
Authorized Official - Last Name:ENGEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:605-639-0115
Mailing Address - Street 1:PO BOX 745
Mailing Address - Street 2:
Mailing Address - City:RAPID CITY
Mailing Address - State:SD
Mailing Address - Zip Code:57709-0745
Mailing Address - Country:US
Mailing Address - Phone:605-347-2770
Mailing Address - Fax:605-342-2770
Practice Address - Street 1:1542 DAVENPORT ST
Practice Address - Street 2:
Practice Address - City:STURGIS
Practice Address - State:SD
Practice Address - Zip Code:57785-2108
Practice Address - Country:US
Practice Address - Phone:605-347-2770
Practice Address - Fax:605-347-2770
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-06
Last Update Date:2015-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD10692310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility