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General NPI Number Information
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NPI Number | 1376408278
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Entity Type | Organization
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Legal Business Name | HOMESTEAD TRAIL LLC
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Dates
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Enumeration Date | 12/22/2025
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Last Update Date | 12/22/2025
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Provider Practice Location Address
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Address Line | 1342 W HOMESTEAD TRL
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City | MEQUON
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State | WI
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Zip | 53092-3213
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Country | US
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Telephone | 262-270-6600
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Fax |
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Provider Business Mailing Address
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Address Line | 1342 W HOMESTEAD TRL
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City | MEQUON
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State | WI
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Zip | 53092-3213
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Country | US
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Telephone | 262-270-6600
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | TYRA ESTAVA
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Credential | CNA
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Telephone | 262-675-3337
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320600000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Residential Treatment Facility
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License Number |
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License Number State |
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