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Organization
PRIOR LAKE OPS LLC
Active
Organization
PRIOR LAKE OPS LLC
Active
Other names
Keystone Prior Lake
Organization subpart
No
Provider details
NPI number
Authorized official
RYAN NOVACZYK (PRESIDENT)
(952) 241-8204
Entity
Organization
Contact information
Practice address
4685 PARK NICOLLET AVE SE, PRIOR LAKE, MN 55372-3926
(952) 226-9200
(952) 226-9201
Mailing address
7625 GOLDEN TRIANGLE DR, SUITE T, EDEN PRAIRIE, MN 55344-3710
(952) 241-8202
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
—
—
Other
Enumeration date
08/03/2015
Last updated
08/03/2015
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