Healthcare Provider Details

I. General information

NPI: 1154043164
Provider Name (Legal Business Name): IVASHKINA VENTURES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/15/2022
Last Update Date: 09/15/2022
Certification Date: 09/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7707 S GARDEN ST
TERRE HAUTE IN
47802-9369
US

IV. Provider business mailing address

7707 S GARDEN ST
TERRE HAUTE IN
47802-9369
US

V. Phone/Fax

Practice location:
  • Phone: 812-814-3564
  • Fax: 260-243-5606
Mailing address:
  • Phone: 812-814-3564
  • Fax: 260-243-5606

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. STEVEN VINCENT STEMPLE
Title or Position: GENERAL MANAGER
Credential:
Phone: 812-229-6890