Provider Demographics
NPI:1952679185
Name:CSL KEYSTONE WOODS, LLC
Entity Type:Organization
Organization Name:CSL KEYSTONE WOODS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:DAWN
Authorized Official - Middle Name:
Authorized Official - Last Name:MOUNT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-308-8338
Mailing Address - Street 1:14755 PRESTON RD STE 810
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75254-6815
Mailing Address - Country:US
Mailing Address - Phone:972-770-5600
Mailing Address - Fax:
Practice Address - Street 1:2335 N MADISON AVE
Practice Address - Street 2:
Practice Address - City:ANDERSON
Practice Address - State:IN
Practice Address - Zip Code:46011-9591
Practice Address - Country:US
Practice Address - Phone:765-642-8020
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CAPITAL SENIOR LIVING
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-12-02
Last Update Date:2024-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201038030AMedicaid