- Enrollment id
- O20150518000045
- Enrollment state
- KS
- Provider type code
- 00-06
- Provider type text
- PART A PROVIDER - HOME HEALTH AGENCY
- Npi
- 1962827170
- Multiple npi flag
- N
- Ccn
- 178105
- Associate id
- 1658691571
- Organization name
- PROVIDENCE HOME HEALTH & HOSPICE LLC.
- Doing business as name
- PROVIDENCE HOME HEALTH AND HOSPICE LLC.
- Incorporation date
- 2014-02-19
- Incorporation state
- KS
- Organization type structure
- LLC
- Proprietary nonprofit
- P
- Address line 1
- 9415 E HARRY ST
- Address line 2
- STE 703
- City
- WICHITA
- State
- KS
- Zip code
- 672075084
- Practice location type
- HHA BRANCH