1033227210 NPI number — HOMESTEAD OF GARDEN CITY NURSING OPERATIONS LLC

Table of content: (NPI 1033227210)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1033227210 NPI number — HOMESTEAD OF GARDEN CITY NURSING OPERATIONS LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HOMESTEAD OF GARDEN CITY NURSING OPERATIONS LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
HOMESTEAD HEALTH AND REHAB CENTER
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1033227210
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/18/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3024 SW WANAMAKER RD STE 300
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TOPEKA
Provider Business Mailing Address State Name:
KS
Provider Business Mailing Address Postal Code:
66614-4498
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
785-272-1535
Provider Business Mailing Address Fax Number:
785-272-1480

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2308 N 3RD ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GARDEN CITY
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
67846
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
620-276-7643
Provider Business Practice Location Address Fax Number:
620-276-8717
Provider Enumeration Date:
08/28/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
KLAUSMAN
Authorized Official First Name:
JAMES
Authorized Official Middle Name:
A
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
785-272-1535

Provider Taxonomy Codes

  • Taxonomy code: 314000000X , with the licence number:  N028001 , registered in the state of KS ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1041543901 , issued by the state of ( KS ) . This identifiers is of the category "MEDICAID".