Proactive Home Care, LLC
Organization Active NPI Home Health Agency · Wichita, KS
NPI 1013979905 · NPPES record last updated Sep 16, 2024
Key facts
- NPI
- 1013979905
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Home Health Agency 251E00000X
- License
- A087055 (KS)
- Legal business name
- PROACTIVE HOME CARE, LLC
- Practice address
- 3450 N Rock Road
Building 200, Suite 213
Wichita, KS 67226-1352 - Phone
- (316) 688-5511
- Fax
- (316) 688-1081
- NPI assigned
- Apr 5, 2006
- Organization subpart
- No
Authorized official
- Name
- Susan Marberry
- Title
- Cco
- Phone
- (903) 390-4040
Owned or controlled facilities with NPI records 2
Member organizations 3
Facilities with the same owner 22
Affiliated clinicians 148
-
Lorraine Alvarado, M.D.
-
Matthew Anthony Arneson, M.D.
-
Leanna Lynn Atterbury, PA-C
-
Mitzi M Bales, MD
-
Erin M Baxa, MD
-
Kirk R Bliss, D.O.
-
Tammy Brewer, FNP-C
-
Lynnette M Brown, ARNP
-
Tyler M Buser, M.D.
-
Jennifer Cheng, DO
-
Brian G Comer, D.O.
-
Jeffrey Cotter, M.D.
-
Kesha Crichlow, M.D.
-
Paul H Davis, M.D.
-
Joe D Davison, M.D.
-
Spencer G Duncan, D.O.
-
Paul Alan Enns, MD
-
Crystal D Faudere, D.O.
Medicare Care Compare: Home health agency
- Listed as
- Phoenix Home Care
- Overall star rating
- ★★★★★ 4.5 of 5
- Ownership
- Proprietary
- Certified
- May 24, 1996
- Medicare certification status
- Active
- Services
- Nursing, Medical social, Home health aide, Physical therapy, Speech pathology, Occupational therapy
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in KS
Home health agency certification: CCN 178012
- Legal name
- PROACTIVE HOME CARE, LLC
- Doing business as
- PHOENIX HOME CARE
- Certification status
- Active
- Provider type (POS)
- Home health agency
- Participating since
- May 24, 1996
- Last certification
- Feb 1, 2018
- Ownership / control type
- Proprietary
- Organization structure
- LLC · Proprietary
- Incorporated
- Jan 24, 1996 in KS
- Enrollment address
- 3450 N Rock Rd
Ste 213
Wichita, KS 67226-1352
All disclosed owners & managing parties 11
| Name | Role | Since | Share |
|---|---|---|---|
| Susan Marberry |
Corporate Officer |
Mar 10, 2026 | |
| Debra R Mullen |
W-2 Managing Employee |
Jan 1, 2017 | |
| Jeffery S Bonham |
Corporate Officer |
Sep 1, 2025 | |
| Corporate Director |
Mar 10, 2026 | ||
| Table Rock Acquisition Co., LLC |
5% Or Greater Indirect Ownership Interest | Oct 20, 2021 | 100% |
| New Day Healthcare Intermediate LLC |
5% Or Greater Indirect Ownership Interest | Oct 20, 2021 | 100% |
| New Day Healthcare, LLC |
5% Or Greater Indirect Ownership Interest | Oct 20, 2021 | 100% |
| Anita Angstadt |
W-2 Managing Employee |
Jul 1, 2017 | |
| Operational/Managerial Control |
Jul 1, 2017 | ||
| Phoenix Healthcare Holdings LLC |
5% Or Greater Direct Ownership Interest | Jan 1, 2013 | 100% |
| New Day Healthcare Holdings, LLC |
5% Or Greater Indirect Ownership Interest | Oct 20, 2021 | 100% |
| Kathy Poland |
Corporate Officer |
Mar 10, 2026 | |
| Corporate Director |
Mar 10, 2026 | ||
| Philip R Melugin |
5% Or Greater Indirect Ownership Interest | Oct 20, 2021 | 7.99% |
| Operational/Managerial Control | Oct 20, 2021 |
All facility ownership & control disclosures 2
| Facility | Type | Role | Since |
|---|---|---|---|
| Phoenix Home Care & Hospice |
Hospice | 5% Or Greater Direct Ownership Interest (100%) | Jun 2, 2014 |
| Phoenix Home Care and Hospice |
Hospice | 5% Or Greater Direct Ownership Interest (100%) | Oct 20, 2021 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20071115000167 | KS | Part a Provider - Home Health Agency | 0840388435 | Practice locations: Hutchinson, KS; Wichita, KS |
National Provider Directory
Locations
1441 E 30th Ave
Ste D
Hutchinson, KS 67502
Phone (620) 412-4993
144 N Oliver Ave
Wichita, KS 67208
Phone (316) 688-5511
Networks
- devoted network organization-4d06b5ed-aefa-4033-b81c-2adf126fd114
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Home Health Agency | 251E00000X | A087055 | KS | Yes |
Addresses
Primary practice location
3450 N Rock Road
Building 200, Suite 213
Wichita, KS 67226-1352
Mailing address
3450 N Rock Road
Building 200, Suite 213
Wichita, KS 67226-1352
Phone (316) 688-5511
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 100242630B | Medicaid | KS | |
| 100242630A | Medicaid | KS | |
| 100242630C | Medicaid | KS |
Other names
- Phoenix Home Care
Other providers in Wichita, KS
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 16, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.