Provider Demographics
NPI:1376545640
Name:REHABILITATION AND VISITING NURSE ASSOCIATION, LLC
Entity Type:Organization
Organization Name:REHABILITATION AND VISITING NURSE ASSOCIATION, LLC
Other - Org Name:REHABILITATION AND VISITING NURSE ASSOCIATION
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:E
Authorized Official - Last Name:NORRIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-712-7522
Mailing Address - Street 1:450 S 900 E STE 100
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84102-2983
Mailing Address - Country:US
Mailing Address - Phone:801-485-6166
Mailing Address - Fax:801-531-1949
Practice Address - Street 1:4850 HAHNS PEAK DR UNIT 100
Practice Address - Street 2:
Practice Address - City:LOVELAND
Practice Address - State:CO
Practice Address - Zip Code:80538-6001
Practice Address - Country:US
Practice Address - Phone:970-330-5655
Practice Address - Fax:970-305-8610
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-01
Last Update Date:2023-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO05700141Medicaid
CO05700141Medicaid
98-06922OtherTAX EXEMPT STATUS
COC31376Medicare PIN