Provider Demographics
NPI:1568670453
Name:VIA CHRISTI HEALTHCARE OUTREACH PROGRAM FOR THE ELDERLY, INC.
Entity Type:Organization
Organization Name:VIA CHRISTI HEALTHCARE OUTREACH PROGRAM FOR THE ELDERLY, INC.
Other - Org Name:HOPE
Other - Org Type:Other Name
Authorized Official - Title/Position:DIRECTOR OF FINANCE
Authorized Official - Prefix:MR
Authorized Official - First Name:KENT
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:SHANK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:316-946-5107
Mailing Address - Street 1:2622 W CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67203-4902
Mailing Address - Country:US
Mailing Address - Phone:316-858-1111
Mailing Address - Fax:
Practice Address - Street 1:2622 W CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67203-4902
Practice Address - Country:US
Practice Address - Phone:316-858-1111
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSH1714251T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251T00000XAgenciesProgram of All-Inclusive Care for the Elderly (PACE) Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
KSH1714Medicare ID - Type UnspecifiedPACE ORGANIZATION