Provider Demographics
NPI:1306526116
Name:VEN HEALTHCARE COUNCIL BLUFFS LLC
Entity type:Organization
Organization Name:VEN HEALTHCARE COUNCIL BLUFFS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:VITHYALAKSHMI
Authorized Official - Middle Name:
Authorized Official - Last Name:SELVARAJ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:712-524-1888
Mailing Address - Street 1:29 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:COUNCIL BLUFFS
Mailing Address - State:IA
Mailing Address - Zip Code:51503-9070
Mailing Address - Country:US
Mailing Address - Phone:712-524-1888
Mailing Address - Fax:
Practice Address - Street 1:29 S MAIN ST
Practice Address - Street 2:
Practice Address - City:COUNCIL BLUFFS
Practice Address - State:IA
Practice Address - Zip Code:51503-9070
Practice Address - Country:US
Practice Address - Phone:712-524-1888
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-18
Last Update Date:2023-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty