Organization
ROSEVILLE OPS LLC
Active
Other names
Keystone Roseville
Organization subpart
No
Provider details
NPI number
Authorized official
RYAN NOVACZYK (PRESIDENT)
(952) 241-8204
Entity
Organization
Contact information
Practice address
2750 VICTORIA ST N, ROSEVILLE, MN 55113-2094
(651) 482-1611
(651) 482-0429
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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