Provider Demographics
NPI:1013796549
Name:KEESTONE SENIOR COMMUNITY, LLC
Entity type:Organization
Organization Name:KEESTONE SENIOR COMMUNITY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MELANIE
Authorized Official - Middle Name:L
Authorized Official - Last Name:STAGGS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:931-766-4097
Mailing Address - Street 1:322 KENNEDY ST
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEBURG
Mailing Address - State:TN
Mailing Address - Zip Code:38464-2122
Mailing Address - Country:US
Mailing Address - Phone:931-766-4097
Mailing Address - Fax:934-244-6080
Practice Address - Street 1:322 KENNEDY ST
Practice Address - Street 2:
Practice Address - City:LAWRENCEBURG
Practice Address - State:TN
Practice Address - Zip Code:38464-2122
Practice Address - Country:US
Practice Address - Phone:931-766-4097
Practice Address - Fax:934-244-6080
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-25
Last Update Date:2023-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility