Provider Demographics
NPI:1114938412
Name:EASTERN IOWA VISITING NURSES AND HOME HEALTH CARE, LLC
Entity Type:Organization
Organization Name:EASTERN IOWA VISITING NURSES AND HOME HEALTH CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:D
Authorized Official - Last Name:FANTON
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:319-465-6299
Mailing Address - Street 1:221 E 1ST ST
Mailing Address - Street 2:
Mailing Address - City:MONTICELLO
Mailing Address - State:IA
Mailing Address - Zip Code:52310-1592
Mailing Address - Country:US
Mailing Address - Phone:319-465-6299
Mailing Address - Fax:319-465-6317
Practice Address - Street 1:221 E 1ST ST
Practice Address - Street 2:
Practice Address - City:MONTICELLO
Practice Address - State:IA
Practice Address - Zip Code:52310-1592
Practice Address - Country:US
Practice Address - Phone:319-465-6299
Practice Address - Fax:319-465-6317
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA167262A251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0672618Medicaid
IA67262OtherBC/BS PROVIDER #
IA0672618Medicaid