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General NPI Number Information
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NPI Number | 1073639365
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Entity Type | Organization
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Legal Business Name | MIDWEST HOMESTEAD OF NORFOLK OPERATIONS LLC
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Dates
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Enumeration Date | 03/21/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 3614 KOENIGSTEIN AVE
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City | NORFOLK
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State | NE
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Zip | 68701-8010
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Country | US
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Telephone | 402-379-9622
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Fax |
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Provider Business Mailing Address
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Address Line | 3715 SW 29TH ST
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City | TOPEKA
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State | KS
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Zip | 66614-2107
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Country | US
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Telephone | 785-272-1535
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Fax |
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Authorized Official
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Title or Position | CFO
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Name | MR. MICHAEL D. TRYON
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Credential |
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Telephone | 785-228-7913
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 313M00000X
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Taxonomy Name | Nursing Facility/Intermediate Care Facility
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License Number |
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License Number State |
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