Provider Demographics
NPI:1376241398
Name:HOMELINK AETNA GEORGIA
Entity Type:Organization
Organization Name:HOMELINK AETNA GEORGIA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP, COMPLIANCE & ACCREDITATION
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:HARBERTS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:855-875-6140
Mailing Address - Street 1:PO BOX 1860
Mailing Address - Street 2:
Mailing Address - City:WATERLOO
Mailing Address - State:IA
Mailing Address - Zip Code:50704-1860
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1111 W SAN MARNAN DR
Practice Address - Street 2:
Practice Address - City:WATERLOO
Practice Address - State:IA
Practice Address - Zip Code:50701-8927
Practice Address - Country:US
Practice Address - Phone:800-642-6065
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:VGM GROUP, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-02-20
Last Update Date:2023-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No251E00000XAgenciesHome Health