PRIOR LAKE OPS LLC NPI 1003292962

NPI Information

  • NPI: 1003292962
  • Provider Name: PRIOR LAKE OPS LLC
  • Classification: Assisted Living Facility - 310400000X
  • Entity Type: Organization
  • Doing Business As: KEYSTONE PRIOR LAKE
  • Address: 4685 PARK NICOLLET AVE SE
    PRIOR LAKE, MN
    ZIP 55372
  • Phone: (952) 226-9200

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NPI Details

PRIOR LAKE OPS LLC is an assisted living facility in Prior Lake, MN. The provider is a facility providing supportive services to individuals who can function independently in most areas of activity, but need assistance and/or monitoring to assure safety and well being. PRIOR LAKE OPS LLC NPI is 1003292962. The provider is registered as an organization entity type.
The provider Is Doing Business As Keystone Prior Lake.

The provider's business location address is:

4685 PARK NICOLLET AVE SE
PRIOR LAKE, MN
ZIP 55372-926
Phone: (952) 226-9200
Fax: (952) 226-9201

The provider's authorized official is Ryan Novaczyk .
The authorized official title is President and has the following contact phone number (952) 241-8204.

The enumeration date for this NPI number is 8/3/2015 and was last updated on 8/3/2015.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1310400000XAssisted Living FacilityYes

What is NPI?

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This page was last updated on: 11/21/2025

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