Basic Information
| Provider Information | |||||||||
| NPI: | 1720328685 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | DEACONESS VNA PLUS, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 3487 | ||||||||
| Address2: | |||||||||
| City: | EVANSVILLE | ||||||||
| State: | IN | ||||||||
| PostalCode: | 477343487 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8124253561 | ||||||||
| FaxNumber: | 8124634600 | ||||||||
| Practice Location | |||||||||
| Address1: | 610 E WALNUT ST | ||||||||
| Address2: | |||||||||
| City: | EVANSVILLE | ||||||||
| State: | IN | ||||||||
| PostalCode: | 477132460 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8124253561 | ||||||||
| FaxNumber: | 8124634600 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/28/2013 | ||||||||
| LastUpdateDate: | 05/09/2015 | ||||||||
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| AuthorizedOfficialLastName: | HORTON | ||||||||
| AuthorizedOfficialFirstName: | GLORIA | ||||||||
| AuthorizedOfficialMiddleName: | D | ||||||||
| AuthorizedOfficialTitleorPosition: | EXECUTIVE DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 8124253561 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251E00000X | 150123 | KY | Y | Agencies | Home Health |
ID Information
| ID | Type | State | Issuer | Description | 157004 | 01 | IN | MEDICARE- INDIANA | OTHER | 147311 | 01 | IL | MEDICARE- ILLINOIS | OTHER | 186268 | 01 | IN | BLUE CROSS EVANSVILLE | OTHER | V255P (657A5)-1475 | 01 | IL | VA PROVIDER- MARION, IL | OTHER | 323484 | 01 | IN | BLUE CROSS TELL CITY | OTHER | 323485 | 01 | IN | BLUE CROSS PRINCETON | OTHER |