MEDICARE: HOMESTEAD NURSING & REHAB CENTER

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	3140N1450X	Pediatric Skilled Nursing Facility		KY

General Provider Information

NPI Number	:	1043205065
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HOMESTEAD NURSING & REHAB CENTER

Provider Business Mailing Address
First Line	:	1608 VERSAILLES RD
Second Line	:
City	:	LEXINGTON
State	:	KY
Zip	:	40504-2402
Country	:	US
Telephone Number	:	859-252-0871
Fax Number	:	859-389-9571

Provider Business Practice Location Address
First Line	:	1608 VERSAILLES RD
Second Line	:
City	:	LEXINGTON
State	:	KY
Zip	:	40504-2402
Country	:	US
Telephone Number	:	859-252-0871
Fax Number	:	859-389-9571

Authorized Official
Title or Position	:	LPN-ADMISSION COORDINATOR
Name	:	MRS. DENISE N/A COOLEY
Credential	:	LPN-AC
Telephone Number	:	859-252-0871

Provider Enumeration Date	:	09/15/2005
Last Update Date	:	07/21/2022

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