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General NPI Number Information
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NPI Number | 1164602462
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Entity Type | Organization
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Legal Business Name | HOMESTEAD ASSISTED LIVING. LLC
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Dates
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Enumeration Date | 11/05/2007
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Last Update Date | 06/09/2025
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Provider Practice Location Address
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Address Line | 802 1ST AVE S
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City | LAKE NORDEN
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State | SD
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Zip | 57248
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Country | US
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Telephone | 605-785-3310
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Fax | 605-785-3320
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Provider Business Mailing Address
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Address Line | P.O. BOX 229 802 1ST AVE S
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City | LAKE NORDEN
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State | SD
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Zip | 57248
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Country | US
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Telephone | 605-785-3310
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Fax | 605-785-3320
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | JOLENE JOHNSON
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Credential |
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Telephone | 605-785-3310
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number | 11072
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License Number State | SD
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