Provider Demographics
NPI:1013157825
Name:RIVERCROSS HOSPICE L.L.C.
Entity Type:Organization
Organization Name:RIVERCROSS HOSPICE L.L.C.
Other - Org Name:RIVERCROSS HEALTHCARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:C
Authorized Official - Last Name:ROWE
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW
Authorized Official - Phone:316-636-9580
Mailing Address - Street 1:PO BOX 781097
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67278-1097
Mailing Address - Country:US
Mailing Address - Phone:316-636-9580
Mailing Address - Fax:316-440-5562
Practice Address - Street 1:251 S WHITTIER ST
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67207-1051
Practice Address - Country:US
Practice Address - Phone:316-636-9580
Practice Address - Fax:316-440-5562
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-06
Last Update Date:2023-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSZ087011251G00000X, 251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200611630AMedicaid