Provider Demographics
NPI:1083601066
Name:VISITING NURSE ASSOCIATION HEALTH SERVICES
Entity Type:Organization
Organization Name:VISITING NURSE ASSOCIATION HEALTH SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:
Authorized Official - Last Name:DELAERE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:586-405-8116
Mailing Address - Street 1:3403 LAPEER RD STE B101
Mailing Address - Street 2:
Mailing Address - City:PORT HURON
Mailing Address - State:MI
Mailing Address - Zip Code:48060-3013
Mailing Address - Country:US
Mailing Address - Phone:810-984-4131
Mailing Address - Fax:877-910-1980
Practice Address - Street 1:3403 LAPEER ROAD
Practice Address - Street 2:BLDG B, SUITE 101
Practice Address - City:PORT HURON
Practice Address - State:MI
Practice Address - Zip Code:48060-2597
Practice Address - Country:US
Practice Address - Phone:810-984-4131
Practice Address - Fax:810-984-0019
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-04
Last Update Date:2023-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0E060OtherBCBS
MI4838823Medicaid
MI4838823Medicaid