Healthcare Provider Details

I. General information

NPI: 1508047523
Provider Name (Legal Business Name): HOMESTEAD CARE CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/19/2007
Last Update Date: 05/27/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1712 MONROE ST
NEW HOLSTEIN WI
53061-1307
US

IV. Provider business mailing address

1726 N BALLARD RD
APPLETON WI
54911-2444
US

V. Phone/Fax

Practice location:
  • Phone: 920-898-4296
  • Fax: 920-898-4931
Mailing address:
  • Phone: 920-991-9072
  • Fax: 920-749-4022

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number2366
License Number StateWI

VIII. Authorized Official

Name: ROBERT M PARKINS
Title or Position: CFO
Credential:
Phone: 920-364-9754