Provider Demographics
NPI:1376765594
Name:VNA HOME SUPPORT SERVICES,INC.
Entity Type:Organization
Organization Name:VNA HOME SUPPORT SERVICES,INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:
Authorized Official - Last Name:GORDON
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:304-242-1554
Mailing Address - Street 1:98 E COVE AVE
Mailing Address - Street 2:
Mailing Address - City:WHEELING
Mailing Address - State:WV
Mailing Address - Zip Code:26003-5080
Mailing Address - Country:US
Mailing Address - Phone:304-242-1544
Mailing Address - Fax:304-242-1677
Practice Address - Street 1:98 E COVE AVE
Practice Address - Street 2:
Practice Address - City:WHEELING
Practice Address - State:WV
Practice Address - Zip Code:26003-5080
Practice Address - Country:US
Practice Address - Phone:304-242-1544
Practice Address - Fax:304-242-1677
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0030974001Medicaid