Provider Demographics
NPI:1669214490
Name:EZRA'S HOMESTEAD
Entity type:Organization
Organization Name:EZRA'S HOMESTEAD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:LOVENIA
Authorized Official - Middle Name:
Authorized Official - Last Name:CHEAD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-733-1790
Mailing Address - Street 1:5900 BALCONES DR # 17760
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78731-4257
Mailing Address - Country:US
Mailing Address - Phone:817-733-1790
Mailing Address - Fax:
Practice Address - Street 1:5828 ARBORLAWN DR APT 1401
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76109-3258
Practice Address - Country:US
Practice Address - Phone:817-733-1790
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PAUL AND LOVENIA ASSOCIATES INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-06-11
Last Update Date:2024-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes315P00000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Intellectual Disabilities
No253Z00000XAgenciesIn Home Supportive Care
No310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
No347C00000XTransportation ServicesPrivate Vehicle