Provider Demographics
NPI:1194047423
Name:ROYAL CHARIOT
Entity type:Organization
Organization Name:ROYAL CHARIOT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:
Authorized Official - Last Name:BACCI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:316-771-7318
Mailing Address - Street 1:3825 E HARRY ST
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67218-3722
Mailing Address - Country:US
Mailing Address - Phone:316-771-7318
Mailing Address - Fax:316-771-7319
Practice Address - Street 1:3825 E HARRY ST
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67218-3722
Practice Address - Country:US
Practice Address - Phone:316-771-7318
Practice Address - Fax:316-771-7319
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-01
Last Update Date:2010-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS200588460B253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200588460BOtherKMAP