NPIMap

Organization Active NPI

Hospice of Wichita Falls, Inc.

  • Community Based Hospice Care Agency
  • Wichita Falls, TX
National Provider Identifier
1770583254
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community Based Hospice Care AgencyTaxonomy code 251G00000X
License
001947 Issued in TX
Legal business name
HOSPICE OF WICHITA FALLS, INC.
Practice address
4909 Johnson Rd
Wichita Falls, TX 76310-2547
Phone
(940) 691-0982
Fax
(940) 691-1608
NPI assigned
Jul 27, 2005
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mrs. Jan Marie Banta, R.N.
Title
Ceo
Phone
(940) 691-0982

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community Based Hospice Care Agency 251G00000X 001947 TX Primary

Addresses

Primary practice location

4909 Johnson Rd
Wichita Falls, TX 76310-2547

Mailing address

PO Box 4804
Wichita Falls, TX 76308-0804
Phone (940) 691-0982

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20051105000312 TX Part A Provider - Hospice 2264450428 Practice locations: Wichita Falls, TX; Vernon, TX

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1770583254. Details of each certification follow.

Hospice certification: CCN 451526

Legal name
HOSPICE OF WICHITA FALLS, INC.
Doing business as
HOSPICE OF WICHITA FALLS
Certification status
Active
Provider type (POS)
Hospice
Participating since
Oct 18, 1988
Last certification
Jan 8, 2021
Ownership / control type
Non-Profit - Other
Organization structure
CorporationNon-profit
Incorporated
Dec 16, 1983 in TX
Enrollment address
4909 Johnson Rd
Wichita Falls, TX 76310-2547

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Care Compare: Hospice

Medicare Care Compare
Listed as
Hospice of Wichita FallsCCN 451526 · All quality measures
Ownership
Non-Profit
Certified
Oct 18, 1988
Medicare certification status
ActiveFrom the Provider of Services file

National Provider Directory

National Provider Directory
Tax ID family
Hospice of Wichita Falls4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

Organizations that report the same tax identification number in the National Provider Directory.

Locations

950 Main St
Sulphur Springs, TX 75482
Phone (214) 766-4927

Ownership & related parties

All disclosed owners & managing parties 21

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Lauren Johnson Individual Corporate Director Jan 1, 2025
Timothy Kevin Thomas Individual Corporate Director Jan 1, 2021
Shunta McFadden Individual Corporate Director Jan 1, 2023
Tessa Alexandra Menchaca Individual Corporate Director Jan 1, 2024
Kristina McCasland Individual Corporate Director Jan 1, 2024
Shana Vordenbaum Individual Corporate Director Jan 1, 2021
Randy Martin Individual Corporate Director Jan 1, 2023
Helen Willingham Individual Corporate Director Jan 1, 2025
Abirami Ravikumar Tanjavur Individual Contracted Managing EmployeeMD; Jan 1, 2023
Cindy Tolentino Individual Corporate Director Jan 1, 2026
Joni Lively Individual Corporate Officer Jul 21, 2025
W-2 Managing EmployeeDirector of Finance Jul 21, 2025
Ann Gunn Individual Corporate Director Jan 1, 2023
Justin Brom Individual Corporate Director Jan 1, 2023
Charla Hoff Individual Corporate Director Jan 1, 2026
Tarvarus Sanders Individual Corporate Director Jan 1, 2022
Lynda Hillery Individual Corporate Director Jan 1, 2024
Alisa Echols Individual Corporate OfficerAdministrator Jan 1, 2010 100%
Corporate DirectorAdministrator Jan 1, 2010
W-2 Managing EmployeeAd; Jan 1, 2010
Jeffrey Morton Individual Corporate Director Jan 1, 2022
Stephanie Robles Individual Corporate Director Jan 1, 2025
Thomas Murchison Individual Corporate Director Jan 1, 2023
Lee Haines Individual Corporate Director Jan 1, 2023

Owners & managing parties with NPI records 2

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

Affiliated clinicians 51

Clinicians who list this facility as an affiliation in Medicare Care Compare.

View all 51

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1122422400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1770583254",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 4804",
            "city": "WICHITA FALLS",
            "state": "TX",
            "postal_code": "763080804",
            "telephone_number": "940-691-0982",
            "fax_number": "940-691-1608"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4909 JOHNSON RD",
            "city": "WICHITA FALLS",
            "state": "TX",
            "postal_code": "763102547",
            "telephone_number": "940-691-0982",
            "fax_number": "940-691-1608"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HOSPICE OF WICHITA FALLS, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-07-27",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "BANTA",
        "authorized_official_first_name": "JAN",
        "authorized_official_middle_name": "MARIE",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "940-691-0982",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "R.N."
    },
    "taxonomies": [
        {
            "code": "251G00000X",
            "taxonomy_group": "",
            "desc": "Hospice Care, Community Based",
            "state": "TX",
            "license": "001947",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Wichita Falls, TX

Sources for this page

Verify at the official NPI Registry.