Provider Demographics
NPI:1326190596
Name:VISITING NURSE ASSOCIATION OF SOUTHEAST MISSOURI INC
Entity Type:Organization
Organization Name:VISITING NURSE ASSOCIATION OF SOUTHEAST MISSOURI INC
Other - Org Name:VISITING NURSE ASSOCIATION OF SOUTHEAST MISSOURI INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:SHONDA
Authorized Official - Middle Name:HOLLOMON
Authorized Official - Last Name:YOUNG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:573-888-5892
Mailing Address - Street 1:PO BOX 768
Mailing Address - Street 2:
Mailing Address - City:KENNETT
Mailing Address - State:MO
Mailing Address - Zip Code:63857-0768
Mailing Address - Country:US
Mailing Address - Phone:573-888-5892
Mailing Address - Fax:
Practice Address - Street 1:1124 INDEPENDENCE AVE
Practice Address - Street 2:
Practice Address - City:KENNETT
Practice Address - State:MO
Practice Address - Zip Code:63857-1314
Practice Address - Country:US
Practice Address - Phone:573-888-5892
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-17
Last Update Date:2022-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO158-22251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO280620204Medicaid