Provider Demographics
NPI:1215077144
Name:VISITING NURSE ASSOC. OF THE WABASH VALLEY,INC.
Entity type:Organization
Organization Name:VISITING NURSE ASSOC. OF THE WABASH VALLEY,INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VP & COO
Authorized Official - Prefix:MRS
Authorized Official - First Name:TRUDY
Authorized Official - Middle Name:
Authorized Official - Last Name:RUPSKA
Authorized Official - Suffix:
Authorized Official - Credentials:RN,MS
Authorized Official - Phone:812-232-7611
Mailing Address - Street 1:400 8TH AVE
Mailing Address - Street 2:
Mailing Address - City:TERRE HAUTE
Mailing Address - State:IN
Mailing Address - Zip Code:47804-4030
Mailing Address - Country:US
Mailing Address - Phone:812-232-7611
Mailing Address - Fax:812-232-1024
Practice Address - Street 1:400 8TH AVE
Practice Address - Street 2:
Practice Address - City:TERRE HAUTE
Practice Address - State:IN
Practice Address - Zip Code:47804-4030
Practice Address - Country:US
Practice Address - Phone:812-232-7611
Practice Address - Fax:812-232-1024
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-08
Last Update Date:2017-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN06-005127-1251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200142120AMedicaid
IN151510Medicare ID - Type UnspecifiedPROVIDER NUMBER