Provider Demographics
NPI:1093821654
Name:MERCYHEALTH VISITING NURSES ASSOCIATION, INC
Entity Type:Organization
Organization Name:MERCYHEALTH VISITING NURSES ASSOCIATION, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FINANCE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:DANETTE
Authorized Official - Middle Name:M
Authorized Official - Last Name:EIBL
Authorized Official - Suffix:
Authorized Official - Credentials:CPA
Authorized Official - Phone:815-971-3773
Mailing Address - Street 1:4223 E STATE ST
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61108-2039
Mailing Address - Country:US
Mailing Address - Phone:815-971-3550
Mailing Address - Fax:815-971-3500
Practice Address - Street 1:4223 E STATE ST
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61108-2039
Practice Address - Country:US
Practice Address - Phone:815-971-3550
Practice Address - Fax:815-971-3500
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-23
Last Update Date:2017-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1002625251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========001Medicaid
147029Medicare ID - Type Unspecified