Provider Demographics
NPI:1770944167
Name:KEYSTONE NURSING CARE CENTER INC D/B/A KEYSTONE HOME HEALTH
Entity type:Organization
Organization Name:KEYSTONE NURSING CARE CENTER INC D/B/A KEYSTONE HOME HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMIN
Authorized Official - Prefix:MS
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:FOWLER
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:319-442-3650
Mailing Address - Street 1:280 5TH ST APT 2
Mailing Address - Street 2:
Mailing Address - City:KEYSTONE
Mailing Address - State:IA
Mailing Address - Zip Code:52249-9533
Mailing Address - Country:US
Mailing Address - Phone:319-442-3650
Mailing Address - Fax:319-442-3660
Practice Address - Street 1:280 5TH ST APT 2
Practice Address - Street 2:
Practice Address - City:KEYSTONE
Practice Address - State:IA
Practice Address - Zip Code:52249-9533
Practice Address - Country:US
Practice Address - Phone:319-442-3650
Practice Address - Fax:319-442-3660
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:KEYSTONE NURSING CARE CENTER INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-03-11
Last Update Date:2018-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA1003246000251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0217044Medicaid
IA167427Medicare Oscar/Certification