Provider Demographics
NPI:1619066776
Name:HOMESTEAD NURSING CENTER OF NEW CASTLE, KENTUCKY, LLC
Entity Type:Organization
Organization Name:HOMESTEAD NURSING CENTER OF NEW CASTLE, KENTUCKY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:BOWMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:859-272-6682
Mailing Address - Street 1:PO BOX 329
Mailing Address - Street 2:
Mailing Address - City:NEW CASTLE
Mailing Address - State:KY
Mailing Address - Zip Code:40050-0329
Mailing Address - Country:US
Mailing Address - Phone:502-845-2861
Mailing Address - Fax:502-845-1287
Practice Address - Street 1:50 ADAMS STREET
Practice Address - Street 2:
Practice Address - City:NEW CASTLE
Practice Address - State:KY
Practice Address - Zip Code:40050-3054
Practice Address - Country:US
Practice Address - Phone:502-845-2861
Practice Address - Fax:502-845-1287
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-12
Last Update Date:2007-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY100435314000000X, 332B00000X, 332BP3500X, 335E00000X
332BN1400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BN1400XSuppliersDurable Medical Equipment & Medical SuppliesNursing Facility Supplies
No332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
No335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY12502282Medicaid
KY000000225678OtherANTHEM BC/BS
KY2705925000OtherPASSPORT ADVANTAGE
KY185362Medicare ID - Type Unspecified
KY0530170001Medicare NSC