Provider Demographics
NPI:1578547865
Name:HOMESTEAD HOSPITAL INC
Entity Type:Organization
Organization Name:HOMESTEAD HOSPITAL INC
Other - Org Name:HOMESTEAD HOSPITAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:
Authorized Official - Last Name:SPELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-662-7111
Mailing Address - Street 1:6855 RED RD
Mailing Address - Street 2:STE 500
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33143-3632
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:786-533-9403
Practice Address - Street 1:975 BAPTIST WAY
Practice Address - Street 2:
Practice Address - City:HOMESTEAD
Practice Address - State:FL
Practice Address - Zip Code:33033-7600
Practice Address - Country:US
Practice Address - Phone:786-243-8000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-01
Last Update Date:2019-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
273Y00000X
FL4486282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
No273Y00000XHospital UnitsRehabilitation Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL40681OtherUNITED HEALTHCARE
FL010226100Medicaid
FL114329OtherAETNA HMO
FL009213OtherAVMED
FL200035OtherAMERIGROUP
FL221OtherBLUE CROSS BLUE SHIELD
FL1508OtherMEDICA
FL6200510OtherAETNA NON HMO
FLHSTEAD1000OtherNEIGHBORHOOD HEALTH
FL40681OtherUNITED HEALTHCARE