Provider Demographics
NPI:1073639365
Name:MIDWEST HOMESTEAD OF NORFOLK OPERATIONS LLC
Entity Type:Organization
Organization Name:MIDWEST HOMESTEAD OF NORFOLK OPERATIONS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:D
Authorized Official - Last Name:TRYON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:785-228-7913
Mailing Address - Street 1:3715 SW 29TH ST
Mailing Address - Street 2:
Mailing Address - City:TOPEKA
Mailing Address - State:KS
Mailing Address - Zip Code:66614-2107
Mailing Address - Country:US
Mailing Address - Phone:785-272-1535
Mailing Address - Fax:
Practice Address - Street 1:3614 KOENIGSTEIN AVE
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:NE
Practice Address - Zip Code:68701-8010
Practice Address - Country:US
Practice Address - Phone:402-379-9622
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility