Healthcare Provider Details

I. General information

NPI: 1720638364
Provider Name (Legal Business Name): HOMESTEAD OF BETHANY OPERATIONS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/16/2019
Last Update Date: 09/16/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4101 N COUNCIL RD
BETHANY OK
73008-3108
US

IV. Provider business mailing address

3024 SW WANAMAKER RD STE 300
TOPEKA KS
66614-4498
US

V. Phone/Fax

Practice location:
  • Phone: 405-787-9200
  • Fax:
Mailing address:
  • Phone: 785-272-1535
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State

VIII. Authorized Official

Name: MR. MICHAEL D TRYON
Title or Position: CFO
Credential: CPA
Phone: 785-272-1535