# KEY STONE HEALTH CARE

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1932520640
- **Authorized official:** LEONARD R JENSEN FNP (PRESIDENT)
- **Authorized official phone:** (503) 523-6404

## Contact information

- **Practice address:** 21 N FISHER PARK WAY, EAGLE, ID 83616-4796
- **Practice address phone:** (208) 514-0670
- **Practice address fax:** (208) 549-7880
- **Mailing address:** 21 N FISHER PARK WAY, EAGLE, ID 83616-4796
- **Mailing address phone:** (208) 514-0670
- **Mailing address fax:** (208) 549-7880

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207QG0300X | Geriatric Medicine (Family Medicine) Physician | — | NULL | — |
| 207QG0300X | Geriatric Medicine (Family Medicine) Physician | — | — | — |
| 207QH0002X | Hospice and Palliative Medicine (Family Medicine) Physician | — | NULL | — |
| 207QH0002X | Hospice and Palliative Medicine (Family Medicine) Physician | — | — | — |
| 363LG0600X | Gerontology Nurse Practitioner | NP-1166A | ID | Yes |

## Other

- **Enumeration date:** 12/23/2013
- **Last updated:** 12/11/2020