Provider Demographics
NPI:1568076578
Name:KEYSTONE PLACE, LLC
Entity Type:Organization
Organization Name:KEYSTONE PLACE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL COUNSEL
Authorized Official - Prefix:
Authorized Official - First Name:BRENDA
Authorized Official - Middle Name:
Authorized Official - Last Name:ARMSTRONG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-409-9252
Mailing Address - Street 1:3965 AIRPORT DR
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46254-5845
Mailing Address - Country:US
Mailing Address - Phone:317-409-9252
Mailing Address - Fax:
Practice Address - Street 1:6126 ROCKWELL DR NE
Practice Address - Street 2:
Practice Address - City:CEDAR RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:52402-4781
Practice Address - Country:US
Practice Address - Phone:319-593-9500
Practice Address - Fax:319-393-9501
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-08
Last Update Date:2020-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174200000XOther Service ProvidersMeals
No177F00000XOther Service ProvidersLodging