Provider Demographics
NPI:1144250515
Name:VISITING NURSE ASSOCIATION OF PORTER COUNTY, INDIANA, INC.
Entity type:Organization
Organization Name:VISITING NURSE ASSOCIATION OF PORTER COUNTY, INDIANA, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT / CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:HOLYCROSS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:219-531-8053
Mailing Address - Street 1:2401 VALLEY DR
Mailing Address - Street 2:
Mailing Address - City:VALPARAISO
Mailing Address - State:IN
Mailing Address - Zip Code:46383-2520
Mailing Address - Country:US
Mailing Address - Phone:219-462-5195
Mailing Address - Fax:219-462-6020
Practice Address - Street 1:2401 VALLEY DR
Practice Address - Street 2:
Practice Address - City:VALPARAISO
Practice Address - State:IN
Practice Address - Zip Code:46383-2520
Practice Address - Country:US
Practice Address - Phone:219-462-5195
Practice Address - Fax:219-462-6020
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:VISITING NURSE ASSOCIATION OF PORTER COUNTY, IN., INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-07-03
Last Update Date:2012-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN06-005259-1251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN0998018OtherAETNA-HMO
IN100272520Medicaid
IN000000097849OtherANTHEM
IN5051OtherBLUE CROSS OF ILLINOIS
IN200342870Medicaid
IN4464973OtherAETNA-PPO
IN200342870Medicaid