| Organization Name: | KEYSTONE COMMUNITIES OF PRIOR LAKE |
| NPI Number: | 1245396084 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | DONNA TEFF (ACCOUNTS SUPERVISOR) |
| Mailing Address: | 4685 Park Nicollet Ave Se Prior Lake |
| State: | MN US |
| Postal Code: | 553723926 |
| Phone Number: | 9528362793 |
| Fax Number: | |
| NPI Enumeration Date: | 12/28/2006 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 177F00000X |
| License Number: | 333604 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MN |
| Taxonomy Type: | Other Service Providers |
| Taxonomy Classification: | Lodging |
| Taxonomy Specialization: | |
| Taxonomy Definition: | A public or privately owned facility providing overnight lodging to individuals traveling long distances or receiving prolonged outpatient medical services away from home. |