Provider Demographics
NPI:1700953304
Name:VIAQUEST HOME HEALTH OF INDIANA, LLC
Entity Type:Organization
Organization Name:VIAQUEST HOME HEALTH OF INDIANA, LLC
Other - Org Name:CARE ONE HOMECARE SERVICES
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:614-339-0820
Mailing Address - Street 1:525 METRO PLACE NORTH, STE 300
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:OH
Mailing Address - Zip Code:43017
Mailing Address - Country:US
Mailing Address - Phone:614-339-0814
Mailing Address - Fax:614-339-1814
Practice Address - Street 1:3409 N BRIARWOOD LN
Practice Address - Street 2:
Practice Address - City:MUNCIE
Practice Address - State:IN
Practice Address - Zip Code:47304-5210
Practice Address - Country:US
Practice Address - Phone:765-289-7531
Practice Address - Fax:765-289-7533
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-29
Last Update Date:2014-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251E00000X
IN011285251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200852440AMedicaid
IN157589Medicare Oscar/Certification