Provider Demographics
NPI:1932167921
Name:ALLIANCE VISITING NURSES
Entity Type:Organization
Organization Name:ALLIANCE VISITING NURSES
Other - Org Name:VNA ALLIANCE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXCECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:KLINE
Authorized Official - Last Name:DUNN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:814-333-7000
Mailing Address - Street 1:18201 CONNEAUT LAKE RD
Mailing Address - Street 2:
Mailing Address - City:MEADVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:16335-3757
Mailing Address - Country:US
Mailing Address - Phone:814-333-7000
Mailing Address - Fax:814-333-7001
Practice Address - Street 1:18360 CONNEAUT LAKE RD STE 2
Practice Address - Street 2:
Practice Address - City:MEADVILLE
Practice Address - State:PA
Practice Address - Zip Code:16335-3735
Practice Address - Country:US
Practice Address - Phone:814-333-7000
Practice Address - Fax:814-333-7001
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-02
Last Update Date:2022-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA765505251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1511871OtherGATWAY INSURANCE
PA39D0910166OtherCLIA WAIVER CERTIFICATE
PA765505OtherPA STATE H/H LICENSE
PA0700144 00OtherDEPT OF LABOR - BLACK LUN
PA675OtherMPI PROVIDER ID
PA1064OtherHIGHMARK
PA0015567230008Medicaid
PA397655Medicare ID - Type UnspecifiedHOME HEALTH CARE MEDICARE