Basic Information
Provider Information | |||||||||
NPI: | 1083863286 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | SAINT JOSEPH-ANC HOME CARE SERVICES, LLC | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: | VNA HEALTH AT HOME | ||||||||
OtherOrganizationType: | 3 | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 6281 TRI RIDGE BLVD STE 300 | ||||||||
Address2: |   | ||||||||
City: | LOVELAND | ||||||||
State: | OH | ||||||||
PostalCode: | 451408345 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 5135760262 | ||||||||
FaxNumber: |   | ||||||||
Practice Location | |||||||||
Address1: | 2464 FORTUNE DR | ||||||||
Address2: | SUITE 110 | ||||||||
City: | LEXINGTON | ||||||||
State: | KY | ||||||||
PostalCode: | 40509 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8592775111 | ||||||||
FaxNumber: |   | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 09/11/2008 | ||||||||
LastUpdateDate: | 07/21/2022 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | HAWKINS | ||||||||
AuthorizedOfficialFirstName: | JACK | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: | VP, FINANCE/CFO | ||||||||
AuthorizedOfficialTelephone: | 5135768478 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | N | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 07/21/2022 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251B00000X |   | KY | N |   | Agencies | Case Management |   | 252Y00000X |   | KY | N |   | Agencies | Early Intervention Provider Agency |   | 251J00000X |   | KY | N |   | Agencies | Nursing Care |   | 251E00000X |   | KY | Y |   | Agencies | Home Health |   |
ID Information
ID | Type | State | Issuer | Description | 7100082990 | 05 | KY |   | MEDICAID | 7100102300 | 01 | KY | MEDICAID EPSDT | OTHER | 7100111840 | 01 | KY | MEDICAID HCBW | OTHER | 7100111850 | 01 | KY | MEDICAID WAIVER | OTHER |