Provider Demographics
NPI:1881698447
Name:LIVINGSTON MEMORIAL VISITING NURSE ASSOCIATION
Entity type:Organization
Organization Name:LIVINGSTON MEMORIAL VISITING NURSE ASSOCIATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR/COO
Authorized Official - Prefix:MRS
Authorized Official - First Name:TERESA
Authorized Official - Middle Name:
Authorized Official - Last Name:PAVAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:805-642-0239
Mailing Address - Street 1:1996 EASTMAN AVE STE 108
Mailing Address - Street 2:
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93003-5769
Mailing Address - Country:US
Mailing Address - Phone:805-642-0239
Mailing Address - Fax:805-642-7402
Practice Address - Street 1:1996 EASTMAN AVE
Practice Address - Street 2:STE 101
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93003-5768
Practice Address - Country:US
Practice Address - Phone:805-642-0239
Practice Address - Fax:805-642-7402
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LIVINGSTON MEMORIAL VISITING NURSE ASSOCIATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-06-10
Last Update Date:2022-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA070000576251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA051517OtherBLUE CROSS HOSPICE PROVID
CAZZZ02348ZOtherBLUE SHIELD PROVIDER NO
CA1881698447Medicaid
CAHPC01517FMedicaid