Keystone Nursing Care Center, Inc
Organization Active NPI Home Health Agency · Keystone, IA
NPI 1003246000 · NPPES record last updated Sep 11, 2018
Key facts
- NPI
- 1003246000
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Home Health Agency 251E00000X
- Legal business name
- KEYSTONE NURSING CARE CENTER, INC
- Practice address
- 280 5TH St
Suite 2
Keystone, IA 52249-9533 - Phone
- (319) 442-3234
- Fax
- (319) 442-3550
- NPI assigned
- Nov 13, 2013
- Organization subpart
- No
Authorized official
- Name
- Ms. Tracy Lynn Hanson, R. N.
- Title
- Administrator
- Phone
- (319) 442-3234
Other NPIs with the same Medicare PAC ID 1
Corporate family (same tax ID) 3
Affiliated clinicians 1
-
Benjamin Miller, D.O.
Medicare Care Compare: Home health agency
- Listed as
- Keystone Home Health
- Overall star rating
- ★★★☆☆ 3 of 5
- Ownership
- Proprietary
- Certified
- Jan 20, 2015
- Medicare certification status
- Active
- Services
- Nursing, Home health aide, Physical therapy, Speech pathology, Occupational therapy
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in IA
Home health agency certification: CCN 167427
- Legal name
- KEYSTONE NURSING CARE CENTER INC
- Doing business as
- KEYSTONE HOME HEALTH
- Certification status
- Active
- Provider type (POS)
- Home health agency
- Participating since
- Jan 20, 2015
- Last certification
- Dec 11, 2020
- Ownership / control type
- Proprietary
- Organization structure
- Corporation · Proprietary
- Incorporated
- Feb 22, 1972 in IA
- Enrollment address
- 250 5TH St
Keystone, IA 52249-9521
All disclosed owners & managing parties 9
| Name | Role | Since | Share |
|---|---|---|---|
| Dave Gahring |
Corporate Director |
Jan 13, 2008 | |
| Angie Hagen |
Corporate Director | Oct 18, 2019 | |
| Operational/Managerial Control |
Oct 18, 2019 | ||
| Cariene Silnanek |
Corporate Director |
Jan 1, 2006 | |
| Rosemary Krutzleldt |
Corporate Director |
Apr 10, 1987 | |
| Ronald Lawrence Garbers |
Corporate Officer |
Nov 11, 2000 | |
| Corporate Director |
Nov 11, 2000 | ||
| Melissa K Lennie |
Corporate Director |
Nov 25, 2013 | |
| Tracy L Bruns |
Corporate Officer |
Oct 27, 2017 | 100% |
| Operational/Managerial Control |
Oct 27, 2017 | 100% | |
| Dean a Franzenburg |
Corporate Director |
Dec 12, 2003 | |
| Kathy Janss |
Corporate Director |
May 21, 2012 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20140331000648 | IA | Part a Provider - Home Health Agency | 8628256898 | Practice locations: Keystone, IA |
National Provider Directory
- Tax ID family
- Keystone Nursing Care Center Inc
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Home Health Agency | 251E00000X | Yes | ||
| Nursing Facility/Intermediate Care Facility | 313M00000X | N263 | IA |
Addresses
Primary practice location
280 5TH St
Suite 2
Keystone, IA 52249-9533
Mailing address
280 5TH St Apt 2
Keystone, IA 52249-9533
Phone (319) 442-3650
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0802140 | Medicaid | IA |
Other names
- Keystone Home Health
Other providers in Keystone, IA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 11, 2018. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.