MEDICARE: HOMESTEAD OF GIRARD OPERATIONS LLC

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	310400000X	Assisted Living Facility

General Provider Information

NPI Number	:	1679275051
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HOMESTEAD OF GIRARD OPERATIONS LLC

Provider Business Mailing Address
First Line	:	3024 SW WANAMAKER RD STE 300
Second Line	:
City	:	TOPEKA
State	:	KS
Zip	:	66614-4498
Country	:	US
Telephone Number	:	785-272-1535
Fax Number	:

Provider Business Practice Location Address
First Line	:	950 W SAINT JOHN ST
Second Line	:
City	:	GIRARD
State	:	KS
Zip	:	66743-2051
Country	:	US
Telephone Number	:	620-724-6760
Fax Number	:

Authorized Official
Title or Position	:	CFO
Name	:	CODY FULKS
Credential	:	CPA
Telephone Number	:	785-272-1535

Provider Enumeration Date	:	03/20/2023
Last Update Date	:	03/20/2023

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