Basic Information
| Provider Information | |||||||||
| NPI: | 1811021132 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | FAITH IN HOME SERVICES, LLC | ||||||||
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| OtherOrganizationName: | HARDEN HOME HEALTH KANSAS | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1703 W 5TH ST | ||||||||
| Address2: | SUITE 800 | ||||||||
| City: | AUSTIN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 787034893 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5126344900 | ||||||||
| FaxNumber: | 5126344966 | ||||||||
| Practice Location | |||||||||
| Address1: | 2622 W CENTRAL AVE | ||||||||
| Address2: | SUITE 401A | ||||||||
| City: | WICHITA | ||||||||
| State: | KS | ||||||||
| PostalCode: | 672034969 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3166186800 | ||||||||
| FaxNumber: | 3166186804 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/16/2007 | ||||||||
| LastUpdateDate: | 10/16/2012 | ||||||||
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| AuthorizedOfficialLastName: | HANSON | ||||||||
| AuthorizedOfficialFirstName: | BENJAMIN | ||||||||
| AuthorizedOfficialMiddleName: | M | ||||||||
| AuthorizedOfficialTitleorPosition: | SR VP AND GENERAL COUNSEL | ||||||||
| AuthorizedOfficialTelephone: | 5126344900 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251E00000X | A087102 | KS | Y | Agencies | Home Health |
ID Information
| ID | Type | State | Issuer | Description | A087102 | 01 | KS | STATE LICENSE NUMBER | OTHER |