Provider Demographics
NPI:1720651854
Name:HOMESTEAD OF KINGFISHER OPERATIONS LLC
Entity Type:Organization
Organization Name:HOMESTEAD OF KINGFISHER OPERATIONS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:D
Authorized Official - Last Name:TRYON
Authorized Official - Suffix:
Authorized Official - Credentials:CPA
Authorized Official - Phone:785-272-1535
Mailing Address - Street 1:3024 SW WANAMAKER RD STE 300
Mailing Address - Street 2:
Mailing Address - City:TOPEKA
Mailing Address - State:KS
Mailing Address - Zip Code:66614-4498
Mailing Address - Country:US
Mailing Address - Phone:785-272-1535
Mailing Address - Fax:
Practice Address - Street 1:1604 S 13TH ST
Practice Address - Street 2:
Practice Address - City:KINGFISHER
Practice Address - State:OK
Practice Address - Zip Code:73750-4619
Practice Address - Country:US
Practice Address - Phone:405-778-2071
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-16
Last Update Date:2021-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility