Provider Demographics
NPI:1639176522
Name:VISITING NURSE GROUP, INC
Entity Type:Organization
Organization Name:VISITING NURSE GROUP, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:CARMELO
Authorized Official - Middle Name:PENA
Authorized Official - Last Name:GUADITE
Authorized Official - Suffix:
Authorized Official - Credentials:RN, BSN
Authorized Official - Phone:215-829-8888
Mailing Address - Street 1:128 W GIRARD AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19123-1622
Mailing Address - Country:US
Mailing Address - Phone:215-829-8888
Mailing Address - Fax:215-829-8875
Practice Address - Street 1:128 W GIRARD AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19123-1622
Practice Address - Country:US
Practice Address - Phone:215-829-8888
Practice Address - Fax:215-829-8875
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA764605251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1006767840004Medicaid
PA1006767840004Medicaid