=====================================================
General NPI Number Information
=====================================================
NPI Number | 1275125064
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | TEMPLE HEALTHCARE AGENCY LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/03/2021
-----------------------------------------------------
Last Update Date | 02/18/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1639 S MERIDIAN AVE STE 6
-----------------------------------------------------
City | WICHITA
-----------------------------------------------------
State | KS
-----------------------------------------------------
Zip | 67213-1941
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 316-869-6775
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1639 S MERIDIAN AVE STE 6
-----------------------------------------------------
City | WICHITA
-----------------------------------------------------
State | KS
-----------------------------------------------------
Zip | 67213-1941
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 316-869-6775
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/CEO/LPN
-----------------------------------------------------
Name | LAQUISHA Q TEMPLE
-----------------------------------------------------
Credential | LPN
-----------------------------------------------------
Telephone | 316-803-3341
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------