Provider Demographics
NPI:1467877571
Name:PROVIDENCE HOME HEALTH & HOSPICE LLC.
Entity Type:Organization
Organization Name:PROVIDENCE HOME HEALTH & HOSPICE LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:CECILIA
Authorized Official - Middle Name:J
Authorized Official - Last Name:WAMBUGU-DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:316-558-5956
Mailing Address - Street 1:9415 E HARRY ST STE 703
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67207-5084
Mailing Address - Country:US
Mailing Address - Phone:316-558-5956
Mailing Address - Fax:316-558-5948
Practice Address - Street 1:9415 E HARRY ST STE 703
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67207
Practice Address - Country:US
Practice Address - Phone:316-558-5956
Practice Address - Fax:316-558-5948
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-26
Last Update Date:2023-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based