Prior Lake Ops LLC

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

Legal business name

PRIOR LAKE OPS LLC

Practice address

4685 Park Nicollet Ave SE
Prior Lake, MN 55372-3926

Phone

(952) 226-9200

Fax

(952) 226-9201

NPI assigned

Aug 3, 2015

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Ryan Novaczyk

Title

President

Phone

(952) 241-8204

Specialties & licenses 1

Addresses

Other names 1

• Keystone Prior Lake Doing business as

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1438560000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1438560000000",
    "number": "1003292962",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7625 GOLDEN TRIANGLE DR",
            "address_2": "SUITE T",
            "city": "EDEN PRAIRIE",
            "state": "MN",
            "postal_code": "553443710",
            "telephone_number": "952-241-8202"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4685 PARK NICOLLET AVE SE",
            "city": "PRIOR LAKE",
            "state": "MN",
            "postal_code": "553723926",
            "telephone_number": "952-226-9200",
            "fax_number": "952-226-9201"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRIOR LAKE OPS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-08-03",
        "last_updated": "2015-08-03",
        "status": "A",
        "authorized_official_last_name": "NOVACZYK",
        "authorized_official_first_name": "RYAN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "952-241-8204"
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Keystone Prior Lake",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Matthew Steven Pivec, PHARM.D.
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• Katherine Price, OTR/L
• Prior Lake
• Prior Lake Natural Health Clinic
• Prior Lake Spine Health & Injury Center, PLLC
• Prior Lake-Savage Independent School District #719
• Charles Walter Puffer, DDS
• Redwood Counseling LLC
• Theresa Rae Reese, APRN, PNP-PC

• Assisted Living Facility in Prior Lake, MN
• Providers in Prior Lake, MN by specialty
• Assisted Living Facility in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 3, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.