Provider Demographics
NPI:1154043164
Name:IVASHKINA VENTURES INC
Entity type:Organization
Organization Name:IVASHKINA VENTURES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:VINCENT
Authorized Official - Last Name:STEMPLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:812-229-6890
Mailing Address - Street 1:7707 S GARDEN ST
Mailing Address - Street 2:
Mailing Address - City:TERRE HAUTE
Mailing Address - State:IN
Mailing Address - Zip Code:47802-9369
Mailing Address - Country:US
Mailing Address - Phone:812-814-3564
Mailing Address - Fax:260-243-5606
Practice Address - Street 1:7707 S GARDEN ST
Practice Address - Street 2:
Practice Address - City:TERRE HAUTE
Practice Address - State:IN
Practice Address - Zip Code:47802-9369
Practice Address - Country:US
Practice Address - Phone:812-814-3564
Practice Address - Fax:260-243-5606
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-15
Last Update Date:2022-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201391170AMedicaid