Homestead Diversity LLC

Primary specialty

Personal Care AttendantTaxonomy code 3747P1801X

Legal business name

HOMESTEAD DIVERSITY LLC

Practice address

3408 E 125TH St
Burnsville, MN 55337-3410

Phone

(515) 230-8902

NPI assigned

May 22, 2023

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Courtny Squibb

Title

Coo

Phone

(515) 230-8902

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1684713600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1684713600000",
    "number": "1114619871",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3408 E 125TH ST",
            "city": "BURNSVILLE",
            "state": "MN",
            "postal_code": "553373410",
            "telephone_number": "515-230-8902"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3408 E 125TH ST",
            "city": "BURNSVILLE",
            "state": "MN",
            "postal_code": "553373410",
            "telephone_number": "515-230-8902"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HOMESTEAD DIVERSITY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-05-22",
        "last_updated": "2023-05-22",
        "certification_date": "2023-05-22",
        "status": "A",
        "authorized_official_last_name": "SQUIBB",
        "authorized_official_first_name": "COURTNY",
        "authorized_official_title_or_position": "COO",
        "authorized_official_telephone_number": "515-230-8902"
    },
    "taxonomies": [
        {
            "code": "3747P1801X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Technician, Personal Care Attendant",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Personal Care Attendant in Burnsville, MN
• Providers in Burnsville, MN by specialty
• Personal Care Attendant in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 22, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.