1033176144 NPI number — OVERLOOK VISITING NURSE ASSOCIATION, INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1033176144 NPI number — OVERLOOK VISITING NURSE ASSOCIATION, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
OVERLOOK VISITING NURSE ASSOCIATION, 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:
OVERLOOK HOSPICE SERVICES
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:
1033176144
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/07/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
88 MASONIC HOME RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHARLTON
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01507-1394
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
800-990-7642
Provider Business Mailing Address Fax Number:
888-978-9808

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
88 MASONIC HOME RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHARLTON
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01507-1394
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
508-434-2200
Provider Business Practice Location Address Fax Number:
888-978-9803
Provider Enumeration Date:
05/01/2006

Additional Information

Authorized Official

Authorized Official Last Name:
HART
Authorized Official First Name:
CHRISTOPHER
Authorized Official Middle Name:
Authorized Official Title or Position:
HOSPICE DIRECTOR OF CLINICAL SERVIC
Authorized Official Telephone Number:
508-434-2439

Provider Taxonomy Codes

  • Taxonomy code: 251G00000X , with the licence number:  77AZ , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251G00000X , 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: 22D1050860 . This is a "CLIA" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 0611794 . This is a "LICENSE" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 120443 . This is a "BLUECROSS BLUESHEILD" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 0611794 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 110024506D . This is a "MASS HEALTH" identifier . This identifiers is of the category "OTHER".




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