MEDICARE: HOMESTEAD OF HIAWATHA 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	310400000X	Assisted Living Facility

General Provider Information

NPI Number	:	1871469510
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HOMESTEAD OF HIAWATHA OPERATIONS LLC

Provider Business Mailing Address
First Line	:	3024 SW WANAMAKER RD STE 300
Second Line	:
City	:	TOPEKA
State	:	KS
Zip	:	66614-4498
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	400 KANSAS AVE
Second Line	:
City	:	HIAWATHA
State	:	KS
Zip	:	66434-1954
Country	:	US
Telephone Number	:	785-742-4566
Fax Number	:

Authorized Official
Title or Position	:	CFO
Name	:	CODY FULKS
Credential	:	CPA
Telephone Number	:	785-272-1535

Provider Enumeration Date	:	10/10/2025
Last Update Date	:	10/10/2025

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