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General NPI Number Information
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NPI Number | 1518069673
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Entity Type | Organization
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Legal Business Name | GOOD SHEPHERD HOSPICE WICHITA LLC
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Dates
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Enumeration Date | 09/01/2006
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Last Update Date | 10/02/2024
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Provider Practice Location Address
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Address Line | 7829 E ROCKHILL STE 403
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City | WICHITA
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State | KS
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Zip | 67206
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Country | US
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Telephone | 316-616-2277
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Fax | 316-616-2288
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Provider Business Mailing Address
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Address Line | 7829 E ROCKHILL STE 403
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City | WICHITA
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State | KS
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Zip | 67206
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Country | US
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Telephone | 316-616-2277
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Fax | 316-616-2288
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. JASON KYLE DELESTER
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Credential |
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Telephone | 405-943-0903
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251G00000X
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Taxonomy Name | Community Based Hospice Care Agency
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License Number | 379858
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License Number State | KS
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