Provider Demographics
NPI:1164602462
Name:HOMESTEAD ASSISTED LIVING. LLC
Entity type:Organization
Organization Name:HOMESTEAD ASSISTED LIVING. LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JOLENE
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:605-785-3310
Mailing Address - Street 1:P.O. BOX 229
Mailing Address - Street 2:802 1ST AVE S
Mailing Address - City:LAKE NORDEN
Mailing Address - State:SD
Mailing Address - Zip Code:57248
Mailing Address - Country:US
Mailing Address - Phone:605-785-3310
Mailing Address - Fax:605-785-3320
Practice Address - Street 1:802 1ST AVE S
Practice Address - Street 2:
Practice Address - City:LAKE NORDEN
Practice Address - State:SD
Practice Address - Zip Code:57248
Practice Address - Country:US
Practice Address - Phone:605-785-3310
Practice Address - Fax:605-785-3320
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-05
Last Update Date:2025-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD11072310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility