Provider Demographics
NPI:1285277939
Name:HOMESTEAD INDEPENDENT SUPPORTED LIVING LLC
Entity type:Organization
Organization Name:HOMESTEAD INDEPENDENT SUPPORTED LIVING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:LORENZ
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:573-514-2744
Mailing Address - Street 1:4849 HIGHWAY B
Mailing Address - Street 2:
Mailing Address - City:HIGBEE
Mailing Address - State:MO
Mailing Address - Zip Code:65257-2845
Mailing Address - Country:US
Mailing Address - Phone:573-514-2744
Mailing Address - Fax:
Practice Address - Street 1:4849 HIGHWAY B
Practice Address - Street 2:
Practice Address - City:HIGBEE
Practice Address - State:MO
Practice Address - Zip Code:65257-2845
Practice Address - Country:US
Practice Address - Phone:573-514-2744
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-25
Last Update Date:2019-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care