=====================================================
General NPI Number Information
=====================================================
NPI Number | 1639585342
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | WICHITA ATTENDANT CARE SERVICES
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/02/2014
-----------------------------------------------------
Last Update Date | 07/02/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2251 S GLENDALE ST
-----------------------------------------------------
City | WICHITA
-----------------------------------------------------
State | KS
-----------------------------------------------------
Zip | 67218-5117
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 316-409-4033
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2251 S GLENDALE ST
-----------------------------------------------------
City | WICHITA
-----------------------------------------------------
State | KS
-----------------------------------------------------
Zip | 67218-5117
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MEMBER
-----------------------------------------------------
Name | CORTEZ NELSON
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 316-409-4033
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number | A-087-166
-----------------------------------------------------
License Number State | KS
-----------------------------------------------------