Provider Demographics
NPI:1679847248
Name:VNA PRIVATE DUTY, LLC
Entity Type:Organization
Organization Name:VNA PRIVATE DUTY, LLC
Other - Org Name:L'AZORE, LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP OPERATIONS
Authorized Official - Prefix:MRS
Authorized Official - First Name:TINA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:NOWAKOWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:443-506-0220
Mailing Address - Street 1:7008 SECURITY BLVD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21244-2566
Mailing Address - Country:US
Mailing Address - Phone:410-277-5920
Mailing Address - Fax:410-753-1222
Practice Address - Street 1:7008 SECURITY BLVD
Practice Address - Street 2:SUITE 300
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21244-2566
Practice Address - Country:US
Practice Address - Phone:410-277-5920
Practice Address - Fax:410-753-1222
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-29
Last Update Date:2012-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR3042251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health