Provider Demographics
NPI:1053315739
Name:LIVINGSTON MEMORIAL VISITING NURSE ASSOCIATION
Entity Type:Organization
Organization Name:LIVINGSTON MEMORIAL VISITING NURSE ASSOCIATION
Other - Org Name:LIVINGSTON MEMORIAL VNA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:TERESA
Authorized Official - Middle Name:
Authorized Official - Last Name:PAVAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:805-642-0239
Mailing Address - Street 1:1996 EASTMAN AVE
Mailing Address - Street 2:STE 101
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93003-5768
Mailing Address - Country:US
Mailing Address - Phone:805-642-0239
Mailing Address - Fax:805-642-7402
Practice Address - Street 1:1996 EASTMAN AVE
Practice Address - Street 2:STE 101
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93003-5768
Practice Address - Country:US
Practice Address - Phone:805-642-0239
Practice Address - Fax:805-642-7402
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-09
Last Update Date:2022-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA050000074251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA057040OtherBLUE CROSS HOME HEALTH NO
CAZZZ97705ZOtherBLUE SHIELD OF CA PROVIDE
CAZZT07040FMedicaid
CAZZZ97705ZOtherBLUE SHIELD OF CA PROVIDE