Basic Information
| Provider Information | |||||||||
| NPI: | 1407122377 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | HOME NURSING AGENCY & VISITING NURSE ASSOCIATION | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 352 HOSPICE SE | ||||||||
| Address2: | 201 CHESTNUT AVENUE | ||||||||
| City: | ALTOONA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 166030352 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8149465411 | ||||||||
| FaxNumber: | 8149408471 | ||||||||
| Practice Location | |||||||||
| Address1: | 761 5TH AVENUE | ||||||||
| Address2: | SUITE A3A | ||||||||
| City: | CHAMBERSBURG | ||||||||
| State: | PA | ||||||||
| PostalCode: | 172012714 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7172642128 | ||||||||
| FaxNumber: | 7172641148 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/26/2012 | ||||||||
| LastUpdateDate: | 07/11/2013 | ||||||||
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| AuthorizedOfficialLastName: | PACKER | ||||||||
| AuthorizedOfficialFirstName: | ROBERT | ||||||||
| AuthorizedOfficialMiddleName: | R | ||||||||
| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 8149465411 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251G00000X | 17531601 | PA | Y | Agencies | Hospice Care, Community Based |
ID Information
| ID | Type | State | Issuer | Description | 1007767800064 | 05 | PA | MEDICAID |