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General NPI Number Information
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NPI Number | 1891910881
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Entity Type | Organization
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Legal Business Name | HOMESTEAD OF OSKALOOSA OPERATIONS LLC
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Dates
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Enumeration Date | 04/16/2007
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Last Update Date | 11/10/2011
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Provider Practice Location Address
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Address Line | 2102 SOUTH MARKET STREET
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City | OSKALOOSA
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State | IA
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Zip | 52577
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Country | US
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Telephone | 641-672-1090
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Fax | 641-672-1116
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Provider Business Mailing Address
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Address Line | 3715 SW 29TH STREET
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City | TOPEKA
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State | KS
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Zip | 66614
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Country | US
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Telephone | 785-272-1535
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Fax | 785-272-1480
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Authorized Official
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Title or Position | CHIEF FINANCIAL OFFICER
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Name | MR. MIKE 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 | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number | S0186
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License Number State | IA
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