1861481681 NPI number — VISITING NURSE AT HIGHLAND, INC

Table of content: (NPI 1861481681)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1861481681 NPI number — VISITING NURSE AT HIGHLAND, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
VISITING NURSE AT HIGHLAND, INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
VNA SENIOR LIVING - HIGHLAND CAMPUS
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1861481681
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/26/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
186 HIGHLAND AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SOMERVILLE
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02143-1507
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
617-776-4420
Provider Business Mailing Address Fax Number:
617-629-7926

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
186 HIGHLAND AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SOMERVILLE
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02143-1507
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
617-776-4420
Provider Business Practice Location Address Fax Number:
617-629-7926
Provider Enumeration Date:
10/14/2005

Additional Information

Authorized Official

Authorized Official Last Name:
CORNELL
Authorized Official First Name:
LINDA
Authorized Official Middle Name:
S.
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
617-776-9800

Provider Taxonomy Codes

  • Taxonomy code: 311Z00000X , with the licence number:  0787 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 314000000X , with the licence number: 0787 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0999032 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".




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