Provider Demographics
NPI:1245236306
Name:VNA HOME HEALTH & HOSPICE
Entity Type:Organization
Organization Name:VNA HOME HEALTH & HOSPICE
Other - Org Name:NORTHERN LIGHT HOME CARE & HOSPICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP - FINANCE & BUSINESS OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:CLARK
Authorized Official - Last Name:KELLNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:207-973-4702
Mailing Address - Street 1:225 GORHAM RD STE 200
Mailing Address - Street 2:
Mailing Address - City:SOUTH PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04106-2462
Mailing Address - Country:US
Mailing Address - Phone:800-757-3326
Mailing Address - Fax:207-400-8891
Practice Address - Street 1:225 GORHAM RD STE 200
Practice Address - Street 2:
Practice Address - City:SOUTH PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04106-2462
Practice Address - Country:US
Practice Address - Phone:800-757-3326
Practice Address - Fax:207-756-8676
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-23
Last Update Date:2022-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME2675251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME012640000Medicaid
ME012640000Medicaid
ME012640000Medicaid