Provider Demographics
NPI:1881173193
Name:KEYSTONE NURSING CARE CENTER INC
Entity type:Organization
Organization Name:KEYSTONE NURSING CARE CENTER INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMIN CEO
Authorized Official - Prefix:
Authorized Official - First Name:TRACY
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:HANSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:319-442-3234
Mailing Address - Street 1:250 5TH ST
Mailing Address - Street 2:
Mailing Address - City:KEYSTONE
Mailing Address - State:IA
Mailing Address - Zip Code:52249-9521
Mailing Address - Country:US
Mailing Address - Phone:131-944-2323
Mailing Address - Fax:
Practice Address - Street 1:250 5TH ST
Practice Address - Street 2:
Practice Address - City:KEYSTONE
Practice Address - State:IA
Practice Address - Zip Code:52249-9521
Practice Address - Country:US
Practice Address - Phone:131-944-2323
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:KEYSTONE NURSING CARE CENTER INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-08-08
Last Update Date:2018-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA165604251J00000X
261QR0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0401XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF)
No251J00000XAgenciesNursing Care