Provider Demographics
NPI:1093759375
Name:VIAQUEST HOME HEALTH OF INDIANA, LLC
Entity Type:Organization
Organization Name:VIAQUEST HOME HEALTH OF INDIANA, LLC
Other - Org Name:CAREONE HOME HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:614-339-0820
Mailing Address - Street 1:525 METRO PLACE NORTH, STE 300
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:OH
Mailing Address - Zip Code:43017-9368
Mailing Address - Country:US
Mailing Address - Phone:614-339-0814
Mailing Address - Fax:614-339-1814
Practice Address - Street 1:14649 HIGHWAY 41 N
Practice Address - Street 2:
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47725-9368
Practice Address - Country:US
Practice Address - Phone:812-473-0100
Practice Address - Fax:877-863-1790
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-16
Last Update Date:2014-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN050059401251E00000X
IN005940251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100265610Medicaid
IN100265610Medicaid