| Entity Name: | VNA SPACE COAST, INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Non-Profit |
| Status: | Active |
| Date Filed: | 06 Apr 2000 (25 years ago) |
| Document Number: | N00000002390 |
| FEI/EIN Number | 651002301 |
| Address: | 391 COMMERCE PKWY, ROCKLEDGE, FL, 32955, US |
| Mail Address: | 445 24th Street, VERO BEACH, FL, 32960, US |
| ZIP code: | 32955 |
| County: | Brevard |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1811994270 | 2005-06-30 | 2023-06-19 | 445 24TH ST STE 300, VERO BEACH, FL, 329607502, US | 391 COMMERCE PKWY STE 240-260, ROCKLEDGE, FL, 329554209, US | |||||||||||||||||||||||||
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| Phone | +1 772-567-5551 |
| Fax | 7725691444 |
Authorized person
| Name | DANIEL J. BACH |
| Role | CFO |
| Phone | 7725675551 |
Taxonomy
| Taxonomy Code | 251E00000X - Home Health Agency |
| License Number | HHA299991471 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICARE PTAN |
| Number | 107632 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| EMMONS REBECCA F | Agent | Rossway Swan Tierney Barry lacey and Olive, VERO BEACH, FL, 32960 |
| Name | Role | Address |
|---|---|---|
| Fegert Ford J | Secretary | 1201 19th Pl, Vero Beach Blvd, FL, 32963 |
| Name | Role | Address |
|---|---|---|
| McCrystal Ann Marie | Director | 511 Bay Drive, Vero Beach, FL, 32963 |
| McGee Mike J | Director | 920 Bowline Dr., Vero Beach, FL, 32963 |
| Name | Role | Address |
|---|---|---|
| JOHNSON RICHARD | Vice Chairman | 859 RIDGE LAKE DRIVE, MELBOURNE, FL, 32940 |
| Name | Role | Address |
|---|---|---|
| FIELDS LUNDY S | Chief Executive Officer | 1110 35TH LANE, VERO BEACH, FL, 32960 |
| Name | Role | Address |
|---|---|---|
| Stengel William | Chairman | 161 Bermuda Bay Lane, VERO BEACH, FL, 32963 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| AMENDED AND RESTATEDARTICLES | 2010-05-27 | No data | No data |
Date of last update: 01 Jan 2025
Sources: Florida Department of State
