Healthcare Provider Details

I. General information

NPI: 1962977017
Provider Name (Legal Business Name): OURKANSAS GUARDIAN LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/04/2018
Last Update Date: 11/22/2022
Certification Date: 11/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9415 E HARRY ST, STE 605
WICHITA KS
67207
US

IV. Provider business mailing address

9415 E HARRY ST, STE 605
WICHITA KS
67207
US

V. Phone/Fax

Practice location:
  • Phone: 316-448-4250
  • Fax:
Mailing address:
  • Phone: 316-448-4250
  • Fax: 316-219-5849

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. SIEGFRIED MBOYA
Title or Position: DIRECTOR OF NURSING
Credential:
Phone: 316-448-4250