- Enrollment id
- O20190320001413
- Enrollment state
- KS
- Provider type code
- 00-06
- Provider type text
- PART A PROVIDER - HOME HEALTH AGENCY
- Npi
- 1962977017
- Multiple npi flag
- N
- Ccn
- 178126
- Associate id
- 7911247424
- Organization name
- OURKANSAS GUARDIAN LLC
- Doing business as name
- OURKANSAS GUARDIAN HOME HEALTH
- Incorporation date
- 2017-05-03
- Incorporation state
- KS
- Organization type structure
- LLC
- Proprietary nonprofit
- P
- Address line 1
- 9415 E HARRY ST
- Address line 2
- STE 605
- City
- WICHITA
- State
- KS
- Zip code
- 672075082