Organization
HOMESTEAD NURSING CENTER, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARK BOWMAN (PRESIDENT)
(859) 272-6682
Entity
Organization
Contact information
Practice address
1608 VERSAILLES ROAD, LEXINGTON, KY 40504-2402
(859) 252-0871
(859) 389-9571
Mailing address
1608 VERSAILLES ROAD, LEXINGTON, KY 40504-2402
(859) 252-0871
(859) 389-9571
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
100108
KY
332B00000X
Durable Medical Equipment & Medical Supplies
100108
KY
332BN1400X
Nursing Facility Supplies (DME)
—
—
332BP3500X
Parenteral & Enteral Nutrition Supplies (DME)
100108
KY
335E00000X
Prosthetic/Orthotic Supplier
100108
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00000054847
ANTHEM BC/BS
KY
05
—
12501003
—
KY
Enumeration date
09/29/2006
Last updated
10/02/2007
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