Provider Demographics
NPI:1184726549
Name:VISITING NURSES ASSOCIATION OF THE ROCKFORD AREA
Entity type:Organization
Organization Name:VISITING NURSES ASSOCIATION OF THE ROCKFORD AREA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:DENISE
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHRADER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:815-971-3744
Mailing Address - Street 1:4223 E STATE ST
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61108-2039
Mailing Address - Country:US
Mailing Address - Phone:815-971-3550
Mailing Address - Fax:915-971-3500
Practice Address - Street 1:2400 N ROCKTON AVE
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61103-3655
Practice Address - Country:US
Practice Address - Phone:815-971-5676
Practice Address - Fax:815-971-3500
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-05
Last Update Date:2012-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL054.0145673336H0001X
IL320.0074023336H0001X
IL051.0381893336H0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336H0001XSuppliersPharmacyHome Infusion Therapy Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========005Medicaid
1162960002Medicare ID - Type Unspecified