Provider Demographics
NPI:1386086171
Name:THERAPEUTIC TIME, LLC
Entity type:Organization
Organization Name:THERAPEUTIC TIME, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LATRECA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:KELLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:316-347-6633
Mailing Address - Street 1:PO BOX 20803
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67208-6803
Mailing Address - Country:US
Mailing Address - Phone:316-347-6633
Mailing Address - Fax:316-744-0714
Practice Address - Street 1:4438 E FALCON ST
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67220-1776
Practice Address - Country:US
Practice Address - Phone:316-347-6633
Practice Address - Fax:316-744-0714
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-23
Last Update Date:2013-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS85352251E00000X, 253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No253Z00000XAgenciesIn Home Supportive Care