Basic Information
Provider Information | |||||||||
NPI: | 1396827796 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | VNA HOME HEALTH SERVICES | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: | WELLSPAN VNA HOME CARE | ||||||||
OtherOrganizationType: | 3 | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 785 5TH AVE STE 3 | ||||||||
Address2: |   | ||||||||
City: | CHAMBERSBURG | ||||||||
State: | PA | ||||||||
PostalCode: | 172014232 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7172639555 | ||||||||
FaxNumber: | 7177096529 | ||||||||
Practice Location | |||||||||
Address1: | 1503 QUENTIN RD | ||||||||
Address2: |   | ||||||||
City: | LEBANON | ||||||||
State: | PA | ||||||||
PostalCode: | 170427431 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7172742591 | ||||||||
FaxNumber: | 7172743923 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 10/19/2006 | ||||||||
LastUpdateDate: | 09/27/2022 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | BUCZKOWSKI | ||||||||
AuthorizedOfficialFirstName: | LAURA | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: | SR VP AND CFO | ||||||||
AuthorizedOfficialTelephone: | 4102590783 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | Y | ||||||||
ParentOrganizationLBN: | WELLSPAN HEALTH | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 09/27/2022 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251G00000X | 156199 | PA | Y |   | Agencies | Hospice Care, Community Based |   |
ID Information
ID | Type | State | Issuer | Description | 1007732780018 | 05 | PA |   | MEDICAID | 1560 | 01 | PA | HIGHMARK BLUE SHIELD | OTHER | 08274 | 01 | PA | HEALTH PARTNERS | OTHER | 391561 | 01 | PA | KEYSTONE HEALTH PLAN CENT | OTHER | 7510 | 01 | PA | AETNA | OTHER | 1018197 | 01 | PA | KEYSTONE MERCY | OTHER | 391561 | 01 |   | GEISINGER GOLD | OTHER | 1521970 | 01 | PA | GATEWAY HEALTH PLAN | OTHER | 33781 | 01 | PA | HEALTH AMERICA | OTHER | 391561 | 01 |   | HUMANA GOLD | OTHER | 391561 | 01 |   | ADVANTRA | OTHER | 391561 | 01 |   | STERLING OPTION 1 | OTHER | 1521970 | 01 | PA | GATEWAY MEDICARE ASSURED | OTHER | 60685 | 01 | PA | AMERIHEALTH MERCY | OTHER | 391561 | 01 | PA | CAPITAL BLUE CROSS | OTHER | 100778621 | 05 | PA |   | MEDICAID |