Provider Demographics
NPI:1285749622
Name:WICHITA HOME CARE EQUIPMENT, INC.
Entity type:Organization
Organization Name:WICHITA HOME CARE EQUIPMENT, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CLIFF
Authorized Official - Middle Name:
Authorized Official - Last Name:WOOLARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:925-680-0638
Mailing Address - Street 1:5046 COMMERCIAL CIR
Mailing Address - Street 2:STE G
Mailing Address - City:CONCORD
Mailing Address - State:CA
Mailing Address - Zip Code:94520-8573
Mailing Address - Country:US
Mailing Address - Phone:925-680-0638
Mailing Address - Fax:
Practice Address - Street 1:5046 COMMERCIAL CIR
Practice Address - Street 2:STE G
Practice Address - City:CONCORD
Practice Address - State:CA
Practice Address - Zip Code:94520-8573
Practice Address - Country:US
Practice Address - Phone:925-680-0638
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-19
Last Update Date:2012-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA100048332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADME00229FMedicaid
CA0190560001OtherPTAN
CA0190560001Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER