Provider Demographics
NPI:1396124343
Name:WICHITA HOME HEALTH CARE LLC
Entity type:Organization
Organization Name:WICHITA HOME HEALTH CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OFFICER MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:
Authorized Official - Last Name:NOLA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:316-312-0931
Mailing Address - Street 1:1738 N MOSLEY ST
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67214-1346
Mailing Address - Country:US
Mailing Address - Phone:316-312-0931
Mailing Address - Fax:
Practice Address - Street 1:1738 N MOSLEY ST
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67214-1346
Practice Address - Country:US
Practice Address - Phone:316-312-0931
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-22
Last Update Date:2015-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSA087179251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health