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General NPI Number Information
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NPI Number | 1992041610
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Entity Type | Organization
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Legal Business Name | MARJORIE'S HOME, LLC
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Dates
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Enumeration Date | 12/27/2012
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Last Update Date | 12/27/2012
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Provider Practice Location Address
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Address Line | 14601 E TIMBER LAKE RD
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City | WICHITA
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State | KS
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Zip | 67230-9220
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Country | US
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Telephone | 316-213-9816
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Fax | 316-977-8809
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Provider Business Mailing Address
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Address Line | 14601 E TIMBER LAKE RD
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City | WICHITA
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State | KS
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Zip | 67230-9220
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Country | US
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Telephone | 316-213-9816
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Fax | 316-977-8809
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Authorized Official
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Title or Position | OWNER
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Name | THERESA REGIER
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Credential |
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Telephone | 316-213-9816
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | B087162
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License Number State | KS
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