Provider Demographics
NPI:1417039116
Name:DEACONESS VNA PLUS, LLC
Entity type:Organization
Organization Name:DEACONESS VNA PLUS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:GLORIA
Authorized Official - Middle Name:D
Authorized Official - Last Name:HORTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:812-425-3561
Mailing Address - Street 1:1300 US HIGHWAY 45 N
Mailing Address - Street 2:
Mailing Address - City:ELDORADO
Mailing Address - State:IL
Mailing Address - Zip Code:62930-3765
Mailing Address - Country:US
Mailing Address - Phone:618-273-9305
Mailing Address - Fax:618-273-2469
Practice Address - Street 1:1300 US HIGHWAY 45 N
Practice Address - Street 2:
Practice Address - City:ELDORADO
Practice Address - State:IL
Practice Address - Zip Code:62930-3765
Practice Address - Country:US
Practice Address - Phone:618-273-9305
Practice Address - Fax:618-273-2469
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-20
Last Update Date:2015-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1011757251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL350868076001Medicaid
IN323485OtherBLUE CROSS PRINCETON
IN323484OtherBLUE CROSS TELL CITY
ILV255P9657A501475OtherVA PROVIDER # MARIAN
IN201266990AMedicaid
KY34-340042OtherKENTUCKY PROVIDER
IN186268OtherBLUE CROSS EVANSVILLE
IN000000323485OtherBLUE CROSS TELL CITY #
ILV255P9657A501475OtherVA PROVIDER # MARIAN
IN0000000323484OtherPRINCETON BLUE CROSS #