Provider Demographics
NPI:1285635714
Name:L & C HOME HEALTH AGENCY INC
Entity Type:Organization
Organization Name:L & C HOME HEALTH AGENCY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMIN
Authorized Official - Prefix:
Authorized Official - First Name:SHAWNA
Authorized Official - Middle Name:KAY
Authorized Official - Last Name:PETERSEN
Authorized Official - Suffix:
Authorized Official - Credentials:LPN
Authorized Official - Phone:785-465-7444
Mailing Address - Street 1:1105 TAYLOR AVE
Mailing Address - Street 2:
Mailing Address - City:COLBY
Mailing Address - State:KS
Mailing Address - Zip Code:67701-9058
Mailing Address - Country:US
Mailing Address - Phone:785-465-7444
Mailing Address - Fax:785-465-7474
Practice Address - Street 1:1105 TAYLOR AVE
Practice Address - Street 2:
Practice Address - City:COLBY
Practice Address - State:KS
Practice Address - Zip Code:67701-9058
Practice Address - Country:US
Practice Address - Phone:785-465-7444
Practice Address - Fax:785-465-7474
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-09
Last Update Date:2021-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSA097003251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS1530OtherBCBS
KS17-8055OtherPTAN
KSA097003Medicare PIN