Provider Demographics
NPI:1407224223
Name:WATERLOO VISITING NURSING ASSOCIATION
Entity Type:Organization
Organization Name:WATERLOO VISITING NURSING ASSOCIATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:CRAWFORD
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:319-235-6201
Mailing Address - Street 1:2530 UNIVERSITY AVE
Mailing Address - Street 2:SUITE3
Mailing Address - City:WATERLOO
Mailing Address - State:IA
Mailing Address - Zip Code:50701-3304
Mailing Address - Country:US
Mailing Address - Phone:319-235-6291
Mailing Address - Fax:319-232-7296
Practice Address - Street 1:2530 UNIVERSITY AVE
Practice Address - Street 2:SUITE 3
Practice Address - City:WATERLOO
Practice Address - State:IA
Practice Address - Zip Code:50701-3304
Practice Address - Country:US
Practice Address - Phone:319-235-6201
Practice Address - Fax:319-232-7296
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-10
Last Update Date:2015-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA167003OtherMEDICAREPTAN
IA0670034Medicaid