MEDICARE: MIDWEST HOMESTEAD OF MASON CITY OPERATIONS 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
1	313M00000X	Nursing Facility/Intermediate Care Facility

General Provider Information

NPI Number	:	1396861787
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MIDWEST HOMESTEAD OF MASON CITY OPERATIONS LLC

Provider Business Mailing Address
First Line	:	3715 SW 29TH ST
Second Line	:
City	:	TOPEKA
State	:	KS
Zip	:	66614-2107
Country	:	US
Telephone Number	:	785-272-1535
Fax Number	:

Provider Business Practice Location Address
First Line	:	2501 W STATE ST
Second Line	:
City	:	MASON CITY
State	:	IA
Zip	:	50401-8916
Country	:	US
Telephone Number	:	641-423-4809
Fax Number	:

Authorized Official
Title or Position	:	CFO
Name	:	MR. MICHAEL D TRYON
Credential	:
Telephone Number	:	785-228-7913

Provider Enumeration Date	:	03/21/2007
Last Update Date	:	08/22/2020

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