Provider Demographics
NPI:1821173790
Name:DEACONESS VNA PLUS, LLC
Entity Type:Organization
Organization Name:DEACONESS VNA PLUS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:LEIGH ANN
Authorized Official - Middle Name:
Authorized Official - Last Name:GAMBLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:812-450-3980
Mailing Address - Street 1:PO BOX 3487
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47734-3487
Mailing Address - Country:US
Mailing Address - Phone:812-425-3561
Mailing Address - Fax:812-463-4600
Practice Address - Street 1:611 HARRIET ST
Practice Address - Street 2:
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47710-1773
Practice Address - Country:US
Practice Address - Phone:812-450-7022
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-26
Last Update Date:2024-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN15-005939-1251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
200141390COtherMEDICAID- TELL CITY
IN200141390BOtherMEDICAID- PRINCETON
IN184508OtherBLUE CROSS PRINCETON
IN257417OtherBLUE CROSS TELL CITY
IN183988OtherBLUE CROSS EVANSVILLE
IN200141390AMedicaid
IN151518Medicare PIN