Basic Information
| Provider Information | |||||||||
| NPI: | 1598060220 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | HOMESTEAD LTC LEASING II, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5198 RICHMOND RD | ||||||||
| Address2: | |||||||||
| City: | BEDFORD HEIGHTS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 441461331 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2168316800 | ||||||||
| FaxNumber: | 2168319734 | ||||||||
| Practice Location | |||||||||
| Address1: | 60 WOOD ST | ||||||||
| Address2: | |||||||||
| City: | PAINESVILLE | ||||||||
| State: | OH | ||||||||
| PostalCode: | 440773332 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4403520788 | ||||||||
| FaxNumber: | 4403522977 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/11/2011 | ||||||||
| LastUpdateDate: | 01/11/2011 | ||||||||
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| AuthorizedOfficialLastName: | BOWER | ||||||||
| AuthorizedOfficialFirstName: | LYNDA | ||||||||
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| AuthorizedOfficialTitleorPosition: | CFO | ||||||||
| AuthorizedOfficialTelephone: | 2168316800 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 314000000X | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
No ID Information.