MEDICARE: HOMESTEAD AT ROCHESTER, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	314000000X	Skilled Nursing Facility

General Provider Information

NPI Number	:	1013347780
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HOMESTEAD AT ROCHESTER, INC.

Provider Business Mailing Address
First Line	:	1900 BALLINGTON BLVD NW
Second Line	:
City	:	ROCHESTER
State	:	MN
Zip	:	55901-5202
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1900 BALLINGTON BLVD NW
Second Line	:
City	:	ROCHESTER
State	:	MN
Zip	:	55901-5202
Country	:	US
Telephone Number	:	507-535-2000
Fax Number	:

Authorized Official
Title or Position	:	ASSISTANT SECRETARY
Name	:	NANCY GAVIN
Credential	:
Telephone Number	:	952-983-4249

Provider Enumeration Date	:	11/18/2013
Last Update Date	:	01/16/2015

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