Provider Demographics
NPI:1245357557
Name:HOME BUDDY
Entity type:Organization
Organization Name:HOME BUDDY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR, CONTRACTS & COMPLIANCE
Authorized Official - Prefix:
Authorized Official - First Name:DAWN
Authorized Official - Middle Name:
Authorized Official - Last Name:FITZGERALD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:508-988-1132
Mailing Address - Street 1:3510 W CENTRAL AVE STE 700
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67203-4926
Mailing Address - Country:US
Mailing Address - Phone:316-262-8339
Mailing Address - Fax:316-941-2856
Practice Address - Street 1:3510 W CENTRAL AVE STE 700
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67203-4926
Practice Address - Country:US
Practice Address - Phone:316-262-8339
Practice Address - Fax:316-941-2856
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-23
Last Update Date:2024-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS332B00000X332B00000X
333300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333300000XSuppliersEmergency Response System Companies
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200327560AMedicaid