Provider Demographics
NPI:1679570519
Name:ANEW HOME HEALTH LC
Entity Type:Organization
Organization Name:ANEW HOME HEALTH LC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER-MANAGING MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:HAYDEN
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:913-649-6060
Mailing Address - Street 1:7933 FRONTAGE RD
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66204-2351
Mailing Address - Country:US
Mailing Address - Phone:913-649-6060
Mailing Address - Fax:913-649-6066
Practice Address - Street 1:7933 FRONTAGE RD
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66204-2351
Practice Address - Country:US
Practice Address - Phone:913-649-6060
Practice Address - Fax:913-649-6066
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-07
Last Update Date:2007-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSA046130251E00000X
MO7232251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO7232OtherSTATE LICENSE
KSA046130OtherSTATE LICENSE
KS5887464301Medicaid
KS178051Medicare ID - Type UnspecifiedPRIMARY SITE