Basic Information
| Provider Information | |||||||||
| NPI: | 1619066776 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | HOMESTEAD NURSING CENTER OF NEW CASTLE, KENTUCKY, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 329 | ||||||||
| Address2: | |||||||||
| City: | NEW CASTLE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 400500329 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5028452861 | ||||||||
| FaxNumber: | 5028451287 | ||||||||
| Practice Location | |||||||||
| Address1: | 50 ADAMS STREET | ||||||||
| Address2: | |||||||||
| City: | NEW CASTLE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 400503054 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5028452861 | ||||||||
| FaxNumber: | 5028451287 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/12/2006 | ||||||||
| LastUpdateDate: | 10/02/2007 | ||||||||
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| AuthorizedOfficialLastName: | BOWMAN | ||||||||
| AuthorizedOfficialFirstName: | MARK | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 8592726682 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 332B00000X | 100435 | KY | N | Suppliers | Durable Medical Equipment & Medical Supplies | 332BP3500X | 100435 | KY | N | Suppliers | Durable Medical Equipment & Medical Supplies | Parenteral & Enteral Nutrition | 335E00000X | 100435 | KY | N | Suppliers | Prosthetic/Orthotic Supplier | 332BN1400X | N | Suppliers | Durable Medical Equipment & Medical Supplies | Nursing Facility Supplies | 314000000X | 100435 | KY | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
ID Information
| ID | Type | State | Issuer | Description | 12502282 | 05 | KY | MEDICAID | 000000225678 | 01 | KY | ANTHEM BC/BS | OTHER | 2705925000 | 01 | KY | PASSPORT ADVANTAGE | OTHER |