Provider Demographics
NPI:1508584632
Name:HOMESTEAD HOMES LLC
Entity Type:Organization
Organization Name:HOMESTEAD HOMES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:THOMASENE
Authorized Official - Middle Name:HARDEN
Authorized Official - Last Name:HERRERA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:757-692-8636
Mailing Address - Street 1:515 HENDERSON STREET
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:VA
Mailing Address - Zip Code:23701-3317
Mailing Address - Country:US
Mailing Address - Phone:757-692-8636
Mailing Address - Fax:757-282-5922
Practice Address - Street 1:515 HENDERSON STREET
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:VA
Practice Address - Zip Code:23701-3317
Practice Address - Country:US
Practice Address - Phone:757-692-8636
Practice Address - Fax:757-282-5922
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-15
Last Update Date:2022-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Multi-Specialty