Keystone Five Star LLC

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

License

334218 Issued in MN

Legal business name

KEYSTONE FIVE STAR LLC

Doing business as

Keystone Bluffs Assisted Living

Practice address

2528 Trinity Rd
Duluth, MN 55811-3315

Phone

(218) 727-2800

NPI assigned

Mar 23, 2007

Organization subpart

No

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

Authorized official

Name

Ms. Lynn Gevik, RN

Title

Coo

Phone

(218) 625-2316

Specialties & licenses 2

Addresses

Other identifiers 3

Other names 1

• Keystone Bluffs Assisted Living Doing business as

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

{
    "created_epoch": "1174608000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1216944000000",
    "number": "1518084847",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2528 TRINITY RD",
            "city": "DULUTH",
            "state": "MN",
            "postal_code": "558113315",
            "telephone_number": "218-727-2800"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2528 TRINITY RD",
            "city": "DULUTH",
            "state": "MN",
            "postal_code": "558113315",
            "telephone_number": "218-727-2800"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KEYSTONE FIVE STAR LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-23",
        "last_updated": "2008-07-25",
        "status": "A",
        "authorized_official_last_name": "GEVIK",
        "authorized_official_first_name": "LYNN",
        "authorized_official_title_or_position": "COO",
        "authorized_official_telephone_number": "218-625-2316",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "RN"
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "MN",
            "license": "334218",
            "primary": true
        },
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "MN",
            "license": "336667",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICA",
            "identifier": "411936451",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FIRST PLAN OF MINNESOTA",
            "identifier": "41-1936451",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE OF MN PROVIDER #",
            "identifier": "660078000",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Keystone Bluffs Assisted Living",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Bobbie Jo Keuten Taylor, HHA
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• Assisted Living Facility in Duluth, MN
• Providers in Duluth, 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 Jul 25, 2008; 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.