Provider Demographics
NPI:1093381055
Name:KANSAS HOMECARE HEROS LLC
Entity Type:Organization
Organization Name:KANSAS HOMECARE HEROS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:
Authorized Official - Last Name:BACCI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:316-771-7315
Mailing Address - Street 1:8335 E KELLOGG DR
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67207-1839
Mailing Address - Country:US
Mailing Address - Phone:316-771-7315
Mailing Address - Fax:316-771-7319
Practice Address - Street 1:8335 E KELLOGG DR
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67207-1839
Practice Address - Country:US
Practice Address - Phone:316-771-7315
Practice Address - Fax:316-771-7319
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WICHITA ATTENDANT CARE SERVICES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-06-01
Last Update Date:2021-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
KSA087188OtherKANSAS STATE HOME HEALTH AGENCY LICENSE