Provider Demographics
NPI:1891965695
Name:KEYSTONE CEDARS
Entity Type:Organization
Organization Name:KEYSTONE CEDARS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:JO
Authorized Official - Last Name:PIPKIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:319-393-9500
Mailing Address - Street 1:6325 ROCKWELL DR NE
Mailing Address - Street 2:
Mailing Address - City:CEDAR RAPIDS
Mailing Address - State:IA
Mailing Address - Zip Code:52402-7203
Mailing Address - Country:US
Mailing Address - Phone:319-393-9500
Mailing Address - Fax:319-393-9501
Practice Address - Street 1:3965 AIRPORT DR
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46254-5845
Practice Address - Country:US
Practice Address - Phone:317-280-8455
Practice Address - Fax:317-875-4051
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:KEYSTONE SENIOR
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-03-07
Last Update Date:2008-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAS0195310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAS0195OtherALP CERTIFICATE