Provider Demographics
NPI:1649317173
Name:BITTERSWEET HOMESTEAD INC
Entity type:Organization
Organization Name:BITTERSWEET HOMESTEAD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:LORETTA
Authorized Official - Middle Name:J
Authorized Official - Last Name:HIATT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:785-872-3719
Mailing Address - Street 1:3181 CHAUTAUQUA RD
Mailing Address - Street 2:
Mailing Address - City:HOLTON
Mailing Address - State:KS
Mailing Address - Zip Code:66436-8032
Mailing Address - Country:US
Mailing Address - Phone:785-872-3719
Mailing Address - Fax:785-872-3717
Practice Address - Street 1:3181 CHAUTAUQUA RD
Practice Address - Street 2:
Practice Address - City:HOLTON
Practice Address - State:KS
Practice Address - Zip Code:66436-8032
Practice Address - Country:US
Practice Address - Phone:785-872-3719
Practice Address - Fax:785-872-3717
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-01
Last Update Date:2013-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS251C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100406430AMedicaid