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NPI Code Detail

MEDICARE: HOMESTEAD NURSING, LLC

MEDICARE: HOMESTEAD NURSING, LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1314000000XSkilled Nursing Facility

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1396028734
Entity Type Code : Organization
Provider Name (Legal Business Name) : HOMESTEAD NURSING, LLC
Provider Business Mailing Address
First Line : 826 NORTH ST
Second Line :
City : STAMPS
State : AR
Zip : 71860-4522
Country : US
Telephone Number : 870-533-4444
Fax Number : 870-533-8841
Provider Business Practice Location Address
First Line : 826 NORTH ST
Second Line :
City : STAMPS
State : AR
Zip : 71860-4522
Country : US
Telephone Number : 870-533-4444
Fax Number : 870-533-8841
Authorized Official
Title or Position : PRESIDENT & CEO
Name : BOYD GENTRY
Credential :
Telephone Number : 937-964-8974
Provider Enumeration Date : 09/22/2011
Last Update Date : 10/19/2011

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