=====================================================
General NPI Number Information
=====================================================
NPI Number | 1194493569
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CORE HOME HEALTH AGENCY LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/01/2021
-----------------------------------------------------
Last Update Date | 03/16/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1861 N ROCK RD STE 380
-----------------------------------------------------
City | WICHITA
-----------------------------------------------------
State | KS
-----------------------------------------------------
Zip | 67206-1288
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 316-941-9698
-----------------------------------------------------
Fax | 316-941-9642
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2311 S REDWOOD AVE
-----------------------------------------------------
City | INDEPENDENCE
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 64057-2405
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 816-795-7990
-----------------------------------------------------
Fax | 816-795-7993
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR OF OPERATIONS
-----------------------------------------------------
Name | BO THOMAS
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 816-795-7990
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------