Provider Demographics
NPI:1336253764
Name:HOMESTEAD HEALTH CENTER, INC
Entity Type:Organization
Organization Name:HOMESTEAD HEALTH CENTER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:E
Authorized Official - Last Name:VESTRING
Authorized Official - Suffix:
Authorized Official - Credentials:ADULT CARE HOME ADMI
Authorized Official - Phone:316-262-4473
Mailing Address - Street 1:2133 S. ELIZABETH
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67213-3403
Mailing Address - Country:US
Mailing Address - Phone:316-262-4473
Mailing Address - Fax:316-262-5939
Practice Address - Street 1:2133 S. ELIZABETH
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67213-3403
Practice Address - Country:US
Practice Address - Phone:316-262-4473
Practice Address - Fax:316-262-5939
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-19
Last Update Date:2013-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSN087006314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100107480AMedicaid
KS175487Medicare Oscar/Certification