- Enrollment id
- O20150908000988
- Enrollment state
- KS
- Provider type code
- 00-08
- Provider type text
- PART A PROVIDER - HOSPICE
- Npi
- 1467877571
- Multiple npi flag
- N
- Ccn
- 171600
- Associate id
- 1658691571
- Organization name
- PROVIDENCE HOME HEALTH & HOSPICE LLC.
- Doing business as name
- PROVIDENCE HOME HEALTH & 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