Provider Demographics
NPI:1508267659
Name:HOMESTEAD OF CENTERVILLE OPERATIONS LLC
Entity Type:Organization
Organization Name:HOMESTEAD OF CENTERVILLE OPERATIONS LLC
Other - Org Name:HOMESTEAD OF CENTERVILLE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFP
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:CPA
Authorized Official - Phone:785-272-1535
Mailing Address - Street 1:3715 SW 29TH ST
Mailing Address - Street 2:SUITE 200
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:785-272-1480
Practice Address - Street 1:19999 SAINT JOSEPH DR
Practice Address - Street 2:
Practice Address - City:CENTERVILLE
Practice Address - State:IA
Practice Address - Zip Code:52544-9032
Practice Address - Country:US
Practice Address - Phone:641-437-1999
Practice Address - Fax:641-437-4258
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-09
Last Update Date:2014-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility