Healthcare Provider Details

I. General information

NPI: 1811021132
Provider Name (Legal Business Name): FAITH IN HOME SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/16/2007
Last Update Date: 10/16/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2622 W CENTRAL AVE SUITE 401A
WICHITA KS
67203-4969
US

IV. Provider business mailing address

1703 W 5TH ST SUITE 800
AUSTIN TX
78703-4893
US

V. Phone/Fax

Practice location:
  • Phone: 316-618-6800
  • Fax: 316-618-6804
Mailing address:
  • Phone: 512-634-4900
  • Fax: 512-634-4966

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License NumberA087102
License Number StateKS

VIII. Authorized Official

Name: BENJAMIN M HANSON
Title or Position: SR VP AND GENERAL COUNSEL
Credential:
Phone: 512-634-4900