Healthcare Provider Details

I. General information

NPI: 1164377925
Provider Name (Legal Business Name): HOMESTEAD CARE SERVICES LLC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/26/2026
Last Update Date: 03/24/2026
Certification Date: 03/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1240 ELK MOUNTAIN CIR
GREEN RIVER WY
82935-5512
US

IV. Provider business mailing address

1240 ELK MOUNTAIN CIR
GREEN RIVER WY
82935-5512
US

V. Phone/Fax

Practice location:
  • Phone: 970-620-2390
  • Fax:
Mailing address:
  • Phone: 970-620-2390
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State

VIII. Authorized Official

Name: TEAH JO DODGE
Title or Position: OWNER/ ADMINISTRATOR
Credential:
Phone: 970-620-2390