=====================================================
General NPI Number Information
=====================================================
NPI Number | 1912732710
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ALL FOUR ONE CARE LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/03/2024
-----------------------------------------------------
Last Update Date | 11/12/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2455 N WOODLAWN BLVD
-----------------------------------------------------
City | WICHITA
-----------------------------------------------------
State | KS
-----------------------------------------------------
Zip | 67220-3996
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 316-247-4890
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2455 N WOODLAWN BLVD
-----------------------------------------------------
City | WICHITA
-----------------------------------------------------
State | KS
-----------------------------------------------------
Zip | 67220-3996
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 316-247-4890
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MISS KYNNEDY JANEECE MOORE
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 405-509-4851
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------