Provider Demographics
NPI:1003093931
Name:HOMESTEAD ASSISTED LIVING
Entity Type:Organization
Organization Name:HOMESTEAD ASSISTED LIVING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASSISTANT ADMINISTRATOR/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:EMERSON
Authorized Official - Last Name:THORNTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:907-745-9040
Mailing Address - Street 1:17635 E PINE NEEDLE WAY
Mailing Address - Street 2:
Mailing Address - City:PALMER
Mailing Address - State:AK
Mailing Address - Zip Code:99645-8275
Mailing Address - Country:US
Mailing Address - Phone:907-745-9040
Mailing Address - Fax:
Practice Address - Street 1:17635 E PINE NEEDLE WAY
Practice Address - Street 2:
Practice Address - City:PALMER
Practice Address - State:AK
Practice Address - Zip Code:99645-8275
Practice Address - Country:US
Practice Address - Phone:907-745-9040
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-22
Last Update Date:2008-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK100637310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility