Provider Demographics
NPI:1508161233
Name:HOMESTEAD LTC LEASING I, LLC
Entity Type:Organization
Organization Name:HOMESTEAD LTC LEASING I, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:LYNDA
Authorized Official - Middle Name:
Authorized Official - Last Name:BOWER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:216-831-6800
Mailing Address - Street 1:5198 RICHMOND RD
Mailing Address - Street 2:
Mailing Address - City:BEDFORD HTS
Mailing Address - State:OH
Mailing Address - Zip Code:44146-1331
Mailing Address - Country:US
Mailing Address - Phone:216-831-6800
Mailing Address - Fax:216-831-9734
Practice Address - Street 1:164 LIBERTY ST
Practice Address - Street 2:
Practice Address - City:PAINESVILLE
Practice Address - State:OH
Practice Address - Zip Code:44077-3331
Practice Address - Country:US
Practice Address - Phone:440-357-6181
Practice Address - Fax:440-357-1142
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-11
Last Update Date:2011-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility