MEDICARE: LEGACY HEALTH KANSAS LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251E00000X	Home Health Agency

General Provider Information

NPI Number	:	1639884182
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LEGACY HEALTH KANSAS LLC

Provider Business Mailing Address
First Line	:	2024 N WOODLAWN ST STE 406
Second Line	:
City	:	WICHITA
State	:	KS
Zip	:	67208-1879
Country	:	US
Telephone Number	:	316-755-8785
Fax Number	:	316-221-2050

Provider Business Practice Location Address
First Line	:	2024 N WOODLAWN ST STE 406
Second Line	:
City	:	WICHITA
State	:	KS
Zip	:	67208-1879
Country	:	US
Telephone Number	:	316-765-4748
Fax Number	:	316-221-2050

Authorized Official
Title or Position	:	OWNER/ADMINISTRATOR
Name	:	MICHELLE D MORALES
Credential	:
Telephone Number	:	316-755-8785

Provider Enumeration Date	:	01/19/2023
Last Update Date	:	11/20/2024

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Directions to “LEGACY HEALTH KANSAS LLC ” Practice Location

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