Provider Demographics
NPI:1992886394
Name:VNA AN AFFILIATE OF WVHCS
Entity type:Organization
Organization Name:VNA AN AFFILIATE OF WVHCS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:ANN
Authorized Official - Middle Name:W
Authorized Official - Last Name:RUSSIN
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:570-552-4000
Mailing Address - Street 1:468 NORTHAMPTON ST
Mailing Address - Street 2:
Mailing Address - City:EDWARDSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:18704-4599
Mailing Address - Country:US
Mailing Address - Phone:570-552-4000
Mailing Address - Fax:570-552-4022
Practice Address - Street 1:468 NORTHAMPTON ST
Practice Address - Street 2:
Practice Address - City:EDWARDSVILLE
Practice Address - State:PA
Practice Address - Zip Code:18704-4599
Practice Address - Country:US
Practice Address - Phone:570-552-4000
Practice Address - Fax:570-552-4022
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA811525OtherFIRST PRIORITY HEALTH
PAIY0447OtherHEALTHNET
PA10077751001Medicaid
PA33485OtherHEALTH AMERICA-PENN STATE
PA391595AMedicare ID - Type Unspecified