Healthcare Provider Details

I. General information

NPI: 1205977832
Provider Name (Legal Business Name): VNA HOMECARE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/08/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3445 BRIDGELAND DR SUITE 117
BRIDGETON MO
63044-2621
US

IV. Provider business mailing address

200 N CENTER DR
ALTON IL
62002-5946
US

V. Phone/Fax

Practice location:
  • Phone: 618-467-3559
  • Fax:
Mailing address:
  • Phone: 618-467-3559
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License Number135-2HO
License Number StateMO

VIII. Authorized Official

Name: SUSAN CHANDARLIS
Title or Position: CFO
Credential: CPA
Phone: 618-467-3559