Provider Demographics
NPI:1275125064
Name:TEMPLE HEALTHCARE AGENCY LLC
Entity Type:Organization
Organization Name:TEMPLE HEALTHCARE AGENCY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CEO/LPN
Authorized Official - Prefix:
Authorized Official - First Name:LAQUISHA
Authorized Official - Middle Name:Q
Authorized Official - Last Name:TEMPLE
Authorized Official - Suffix:
Authorized Official - Credentials:LPN
Authorized Official - Phone:316-803-3341
Mailing Address - Street 1:1639 S MERIDIAN AVE STE 6
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67213-1941
Mailing Address - Country:US
Mailing Address - Phone:316-869-6775
Mailing Address - Fax:
Practice Address - Street 1:1639 S MERIDIAN AVE STE 6
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67213-1941
Practice Address - Country:US
Practice Address - Phone:316-869-6775
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-03
Last Update Date:2023-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251E00000XAgenciesHome HealthGroup - Single Specialty