Active NPI
Providence Home Health & Hospice LLC
- Home Health Agency
- Wichita, KS
National Provider Identifier
1962827170
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Home Health Agency
- Legal business name
- PROVIDENCE HOME HEALTH & HOSPICE LLC
- Practice address
- 9415 E Harry St Ste 703
Wichita, KS 67207 - Phone
- (316) 992-8578
- Fax
- (316) 558-5956
- NPI assigned
- Feb 25, 2014
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Mrs. Cecilia J Wambugu-Davis
- Title
- Administrator
- Phone
- (316) 558-5956
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Home Health Agency | 251E00000X | Primary |
Addresses
Primary practice location
9415 E Harry St Ste 703
Wichita, KS 67207
Mailing address
9415 E Harry St Ste 703
Wichita, KS 67207-5084
Phone (316) 558-5956
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in KS
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20150518000045 | KS | Part A Provider - Home Health Agency | 1658691571 | Practice locations: Wichita, KS |
Home health agency certification: CCN 178105
- Legal name
- PROVIDENCE HOME HEALTH & HOSPICE LLC.
- Doing business as
- PROVIDENCE HOME HEALTH AND HOSPICE LLC.
- Certification status
- Active
- Provider type (POS)
- Home health agency
- Participating since
- Sep 17, 2015
- Last certification
- Sep 17, 2015
- Ownership / control type
- Proprietary
- Organization structure
- LLC
- Incorporated
- Feb 19, 2014 in KS
- Enrollment address
- 9415 E Harry St
Ste 703
Wichita, KS 67207-5084
Other NPIs with the same Medicare PAC ID 1
NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).
-
- Community Based Hospice Care Agency
- Wichita, KS
- NPI 1467877571
1658691571
Care Compare: Home health agency
Medicare Care Compare- Listed as
- Providence Home Health and Hospice, LLC
- Overall star rating
- Ownership
- Proprietary
- Certified
- Sep 17, 2015
- Medicare certification status
- Active
- Services
- Nursing, Medical social, Home health aide, Physical therapy, Speech pathology, Occupational therapy
National Provider Directory
National Provider Directory- Tax ID family
- Providence Home Health
Other organizations with this tax ID 1
Organizations that report the same tax identification number in the National Provider Directory.
-
- Community Based Hospice Care Agency
- Wichita, KS
- NPI 1467877571
Locations
9415 E Harry St
Ste 703
Wichita, KS 67207
Phone (316) 558-5956
Ownership & related parties
All disclosed owners & managing parties 2
As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.
| Name | Role | Since | Share |
|---|---|---|---|
| Cecilia Wambugu-Davis | 5% Or Greater Direct Ownership Interest | Feb 19, 2014 | 55% |
| Corporate Officer | Feb 19, 2014 | ||
| Corporate Director | Feb 19, 2014 | ||
| W-2 Managing Employee | Feb 19, 2014 | ||
| Patrick N Mwangi | 5% Or Greater Direct Ownership Interest | Feb 19, 2014 | 45% |
| Corporate Officer | Feb 19, 2014 | ||
| Corporate Director | Feb 19, 2014 | ||
| W-2 Managing Employee | Feb 19, 2014 |
Practitioners & affiliated clinicians
Affiliated clinicians 11
Clinicians who list this facility as an affiliation in Medicare Care Compare.
-
- Geriatric Medicine (Internal Medicine) Physician
- Wichita, KS
- NPI 1982654638
Home health agency
-
- Family Nurse Practitioner
- Wichita, KS
- NPI 1396320958
Home health agency
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1393286400000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1674518400000",
"number": "1962827170",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "9415 E HARRY ST STE 703",
"city": "WICHITA",
"state": "KS",
"postal_code": "672075084",
"telephone_number": "316-558-5956",
"fax_number": "316-558-5948"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "9415 E HARRY ST STE 703",
"city": "WICHITA",
"state": "KS",
"postal_code": "67207",
"telephone_number": "316-992-8578",
"fax_number": "316-558-5956"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "PROVIDENCE HOME HEALTH & HOSPICE LLC",
"organizational_subpart": "NO",
"enumeration_date": "2014-02-25",
"last_updated": "2023-01-24",
"certification_date": "2023-01-24",
"status": "A",
"authorized_official_last_name": "WAMBUGU-DAVIS",
"authorized_official_first_name": "CECILIA",
"authorized_official_middle_name": "J",
"authorized_official_title_or_position": "ADMINISTRATOR",
"authorized_official_telephone_number": "316-558-5956",
"authorized_official_name_prefix": "Mrs."
},
"taxonomies": [
{
"code": "251E00000X",
"taxonomy_group": "",
"desc": "Home Health",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Wichita, KS
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 24, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.