Healthcare Provider Details

I. General information

NPI: 1326131574
Provider Name (Legal Business Name): FAITH HOME HEALTH & HOSPICE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/02/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7804 E FUNSTON ST STE 203
WICHITA KS
67207-3107
US

IV. Provider business mailing address

7804 E FUNSTON ST STE 203
WICHITA KS
67207-3107
US

V. Phone/Fax

Practice location:
  • Phone: 316-618-6800
  • Fax: 316-618-6800
Mailing address:
  • Phone: 316-618-6800
  • Fax: 316-618-6800

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License NumberA087089
License Number StateKS

VIII. Authorized Official

Name: MRS. KELLY L BOWLIN
Title or Position: ADMINISTRATOR
Credential:
Phone: 316-618-6800