Provider Demographics
NPI:1194442822
Name:ELIZABETH BREWSTER HOUSE
Entity type:Organization
Organization Name:ELIZABETH BREWSTER HOUSE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:KILMER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:607-749-2442
Mailing Address - Street 1:41 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HOMER
Mailing Address - State:NY
Mailing Address - Zip Code:13077-1394
Mailing Address - Country:US
Mailing Address - Phone:607-749-2442
Mailing Address - Fax:607-749-5862
Practice Address - Street 1:41 S MAIN ST
Practice Address - Street 2:
Practice Address - City:HOMER
Practice Address - State:NY
Practice Address - Zip Code:13077-1394
Practice Address - Country:US
Practice Address - Phone:607-749-2442
Practice Address - Fax:607-749-5862
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-24
Last Update Date:2022-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home