Provider Demographics
NPI:1851761332
Name:HOMESTEAD ESTATES HOME PLUS
Entity Type:Organization
Organization Name:HOMESTEAD ESTATES HOME PLUS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPERATOR
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:L
Authorized Official - Last Name:LOCK-GOOCH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:620-626-5672
Mailing Address - Street 1:1140 S PERSHING AVE
Mailing Address - Street 2:
Mailing Address - City:LIBERAL
Mailing Address - State:KS
Mailing Address - Zip Code:67901-4519
Mailing Address - Country:US
Mailing Address - Phone:620-626-5672
Mailing Address - Fax:620-626-0895
Practice Address - Street 1:1140 S PERSHING AVE
Practice Address - Street 2:
Practice Address - City:LIBERAL
Practice Address - State:KS
Practice Address - Zip Code:67901-4519
Practice Address - Country:US
Practice Address - Phone:620-626-5672
Practice Address - Fax:620-626-0895
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-28
Last Update Date:2015-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSB088002311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home