Provider Demographics
NPI:1114343720
Name:VNA OF NORTHWEST PA, LLC
Entity Type:Organization
Organization Name:VNA OF NORTHWEST PA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REAPONSIBLE OFFICER OF THE BOARD
Authorized Official - Prefix:
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:A
Authorized Official - Last Name:AHLSTROM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:716-630-8293
Mailing Address - Street 1:1223 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BRADFORD
Mailing Address - State:PA
Mailing Address - Zip Code:16701-3223
Mailing Address - Country:US
Mailing Address - Phone:814-362-7466
Mailing Address - Fax:814-362-4306
Practice Address - Street 1:1223 E MAIN ST
Practice Address - Street 2:
Practice Address - City:BRADFORD
Practice Address - State:PA
Practice Address - Zip Code:16701-3223
Practice Address - Country:US
Practice Address - Phone:814-362-7466
Practice Address - Fax:814-362-4306
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-07
Last Update Date:2015-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA151099251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
2762OtherBLUE CROSS
PA1029007450001Medicaid
PA391510BMedicare Oscar/Certification