Provider Demographics
NPI:1972554152
Name:WELLSTREAM HEALTH SERVICES LLC
Entity Type:Organization
Organization Name:WELLSTREAM HEALTH SERVICES LLC
Other - Org Name:KINDRED AT HOME
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ASSISTANT SECRETARY
Authorized Official - Prefix:MS
Authorized Official - First Name:RUTH
Authorized Official - Middle Name:C
Authorized Official - Last Name:SCHWARTZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:913-814-2288
Mailing Address - Street 1:12900 FOSTER ST
Mailing Address - Street 2:SUITE 400
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66213-2704
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1920 CORPORATE DR
Practice Address - Street 2:SUITE A-108
Practice Address - City:SAN MARCOS
Practice Address - State:TX
Practice Address - Zip Code:78666-6283
Practice Address - Country:US
Practice Address - Phone:512-392-0157
Practice Address - Fax:512-392-0611
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-13
Last Update Date:2016-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX014462251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX09516420-3OtherCSHCN
TX09516420Medicaid
45D0505671OtherCLIA
TX57893OtherMEDICAID DME H
TX001002300OtherMDCP
TX001002300OtherMDCP