Provider Demographics
NPI:1245416932
Name:HOME NURSING AGENCY & VISITING NURSE ASSOCIATION
Entity Type:Organization
Organization Name:HOME NURSING AGENCY & VISITING NURSE ASSOCIATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:PHILIP
Authorized Official - Middle Name:L
Authorized Official - Last Name:FREEMAN
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:814-946-5411
Mailing Address - Street 1:201 CHESTNUT AVE
Mailing Address - Street 2:PHC
Mailing Address - City:ALTOONA
Mailing Address - State:PA
Mailing Address - Zip Code:16601-4927
Mailing Address - Country:US
Mailing Address - Phone:814-946-5411
Mailing Address - Fax:814-942-1673
Practice Address - Street 1:350 LAKEMONT PARK BLVD
Practice Address - Street 2:PHC
Practice Address - City:ALTOONA
Practice Address - State:PA
Practice Address - Zip Code:16602-5946
Practice Address - Country:US
Practice Address - Phone:814-946-5411
Practice Address - Fax:814-941-1628
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HOME NURSING AGENCY & VISITING NURSE ASSOCIATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-01-14
Last Update Date:2015-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163W00000XNursing Service ProvidersRegistered NurseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1007767800063Medicaid