Provider Demographics
NPI:1720328685
Name:DEACONESS VNA PLUS, LLC
Entity Type:Organization
Organization Name:DEACONESS VNA PLUS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICER
Authorized Official - Prefix:
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 1:611 HARRIET ST
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47710-1773
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:812-425-3561
Practice Address - Fax:812-463-4600
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-28
Last Update Date:2023-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY150123251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL147311OtherMEDICARE- ILLINOIS
IN157004OtherMEDICARE- INDIANA
IN186268OtherBLUE CROSS EVANSVILLE
IN323485OtherBLUE CROSS PRINCETON
IN323484OtherBLUE CROSS TELL CITY
ILV255P (657A5)-1475OtherVA PROVIDER- MARION, IL