Organization
PROACTIVE HOME CARE, LLC
Active
Other names
Phoenix Home Care
Organization subpart
No
Provider details
NPI number
Authorized official
SUSAN MARBERRY (CCO)
(903) 390-4040
Entity
Organization
Contact information
Practice address
3450 N ROCK ROAD, BUILDING 200, SUITE 213, WICHITA, KS 67226-1352
(316) 688-5511
(316) 688-1081
Mailing address
3450 N ROCK ROAD, BUILDING 200, SUITE 213, WICHITA, KS 67226-1352
(316) 688-5511
(316) 688-1081
Taxonomy
Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
Primary
A087055
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100242630A
—
KS
05
—
100242630B
—
KS
05
—
100242630C
—
KS
Enumeration date
04/05/2006
Last updated
09/16/2024
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