1700953304 NPI number — VIAQUEST HOME HEALTH OF INDIANA, LLC

Table of content: (NPI 1700953304)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1700953304 NPI number — VIAQUEST HOME HEALTH OF INDIANA, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
VIAQUEST HOME HEALTH OF INDIANA, 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:
Provider Other Organization Name Type Code:
6
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:
1700953304
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/25/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
525 METRO PLACE NORTH, STE 300
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DUBLIN
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
43017
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
614-339-0814
Provider Business Mailing Address Fax Number:
614-339-1814

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3409 N BRIARWOOD LN
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MUNCIE
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
47304-5210
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
765-289-7531
Provider Business Practice Location Address Fax Number:
765-289-7533
Provider Enumeration Date:
11/29/2006

Additional Information

Authorized Official

Authorized Official Last Name:
JOHNSON
Authorized Official First Name:
RICHARD
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
614-339-0820

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251E00000X , with the licence number: 011285 , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 200852440A , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".




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