Provider Demographics
NPI:1811994270
Name:VNA SPACE COAST, INC.
Entity type:Organization
Organization Name:VNA SPACE COAST, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:BACH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:772-567-5551
Mailing Address - Street 1:445 24TH ST STE 300
Mailing Address - Street 2:
Mailing Address - City:VERO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32960-7502
Mailing Address - Country:US
Mailing Address - Phone:772-567-5551
Mailing Address - Fax:772-569-1444
Practice Address - Street 1:391 COMMERCE PKWY STE 240-260
Practice Address - Street 2:
Practice Address - City:ROCKLEDGE
Practice Address - State:FL
Practice Address - Zip Code:32955-4209
Practice Address - Country:US
Practice Address - Phone:772-567-5551
Practice Address - Fax:772-569-1444
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-30
Last Update Date:2023-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLHHA299991471251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL107632OtherMEDICARE PTAN