1306973912 NPI number — ALWAYS THERE HOME CARE, LLC

Table of content: (NPI 1306973912)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1306973912 NPI number — ALWAYS THERE HOME CARE, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ALWAYS THERE HOME CARE, 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:
WALTER L GIBSON, MEMBER
Provider Other Organization Name Type Code:
4
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:
1306973912
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/06/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 493
Provider Second Line Business Mailing Address:
112 N PENN AVE
Provider Business Mailing Address City Name:
INDEPENDENCE
Provider Business Mailing Address State Name:
KS
Provider Business Mailing Address Postal Code:
67301-0493
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
620-331-0070
Provider Business Mailing Address Fax Number:
620-331-2952

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
112 N PENN AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
INDEPENDENCE
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
67301-3524
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
620-331-0070
Provider Business Practice Location Address Fax Number:
620-331-2952
Provider Enumeration Date:
02/28/2007

Additional Information

Authorized Official

Authorized Official Last Name:
GIBSON
Authorized Official First Name:
WALLY
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER/CEO/MANAGING MEMBER
Authorized Official Telephone Number:
620-331-0070

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 332BX2000X , with the licence number: 16-00196 , 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: 626360200 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0000118142 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( KS ) . This identifiers is of the category "OTHER".
  • Identifier: 200003800A , issued by the state of ( KS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 200003800B , issued by the state of ( KS ) . This identifiers is of the category "MEDICAID".




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