Basic Information
| Provider Information | |||||||||
| NPI: | 1962072637 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | HOMESTEAD HOSPITAL, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6855 S RED RD STE 600 | ||||||||
| Address2: | |||||||||
| City: | SOUTH MIAMI | ||||||||
| State: | FL | ||||||||
| PostalCode: | 331433518 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 975 BAPTIST WAY | ||||||||
| Address2: | |||||||||
| City: | HOMESTEAD | ||||||||
| State: | FL | ||||||||
| PostalCode: | 330337600 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7862438000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/25/2021 | ||||||||
| LastUpdateDate: | 06/25/2021 | ||||||||
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| AuthorizedOfficialLastName: | SPELL | ||||||||
| AuthorizedOfficialFirstName: | KENNETH | ||||||||
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| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 7862438000 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 06/04/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 332900000X | Y | Suppliers | Non-Pharmacy Dispensing Site |
No ID Information.