1376545640 NPI number — REHABILITATION AND VISITING NURSE ASSOCIATION, LLC

Table of content: (NPI 1376545640)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1376545640 NPI number — REHABILITATION AND VISITING NURSE ASSOCIATION, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
REHABILITATION AND VISITING NURSE ASSOCIATION, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
REHABILITATION AND VISITING NURSE ASSOCIATION
Provider Other Organization Name Type Code:
4
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1376545640
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/06/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
450 S 900 E STE 100
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SALT LAKE CITY
Provider Business Mailing Address State Name:
UT
Provider Business Mailing Address Postal Code:
84102-2983
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
801-485-6166
Provider Business Mailing Address Fax Number:
801-531-1949

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4850 HAHNS PEAK DR UNIT 100
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LOVELAND
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80538-6001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
970-330-5655
Provider Business Practice Location Address Fax Number:
970-305-8610
Provider Enumeration Date:
06/01/2005

Additional Information

Authorized Official

Authorized Official Last Name:
NORRIS
Authorized Official First Name:
KENNETH
Authorized Official Middle Name:
E
Authorized Official Title or Position:
MANAGING PARTNER
Authorized Official Telephone Number:
801-712-7522

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 05700141 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".




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