1235132119 NPI number — VIA CHRISTI HOME HEALTH WICHITA, LLC

Table of content: (NPI 1235132119)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1235132119 NPI number — VIA CHRISTI HOME HEALTH WICHITA, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
VIA CHRISTI HOME HEALTH WICHITA, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
VIA CHRISTI HOME HEALTH
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1235132119
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/02/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
555 S WASHINGTON ST
Provider Second Line Business Mailing Address:
SUITE 103
Provider Business Mailing Address City Name:
WICHITA
Provider Business Mailing Address State Name:
KS
Provider Business Mailing Address Postal Code:
67211-2424
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
316-268-8588
Provider Business Mailing Address Fax Number:
316-264-1265

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
555 S WASHINGTON ST STE 103
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WICHITA
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
67211-2424
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
316-268-8588
Provider Business Practice Location Address Fax Number:
316-264-1265
Provider Enumeration Date:
05/24/2005

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
SCOTT
Authorized Official First Name:
JOY
Authorized Official Middle Name:
M
Authorized Official Title or Position:
DIRECTOR
Authorized Official Telephone Number:
316-858-2112

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , with the licence number:  A87006 , registered in the state of KS ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 100241930A , issued by the state of ( KS ) . This identifiers is of the category "MEDICAID".