Provider Demographics
NPI:1487652905
Name:HOMESTEAD VILLAGE INC
Entity type:Organization
Organization Name:HOMESTEAD VILLAGE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:V
Authorized Official - Last Name:MOTTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:717-397-4831
Mailing Address - Street 1:1800 VILLAGE CIR
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17603-2376
Mailing Address - Country:US
Mailing Address - Phone:717-397-4831
Mailing Address - Fax:717-397-5647
Practice Address - Street 1:1800 VILLAGE CIR
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17603-2376
Practice Address - Country:US
Practice Address - Phone:717-397-4831
Practice Address - Fax:717-397-5647
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-08
Last Update Date:2023-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA085902314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0010636500002Medicaid
PA0010636500002Medicaid