1730112962 NPI number — NATICK VISITING NURSE ASSN

Table of content: (NPI 1730112962)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1730112962 NPI number — NATICK VISITING NURSE ASSN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NATICK VISITING NURSE ASSN
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:
Provider Other Organization Name Type Code:
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:
1730112962
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/11/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
209 WEST CENTRAL STREET
Provider Second Line Business Mailing Address:
SUITE 313
Provider Business Mailing Address City Name:
NATICK
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01760-3759
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
508-653-3081
Provider Business Mailing Address Fax Number:
508-653-8276

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
209 WEST CENTRAL STREET
Provider Second Line Business Practice Location Address:
SUITE 313
Provider Business Practice Location Address City Name:
NATICK
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01760-3759
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
508-653-3081
Provider Business Practice Location Address Fax Number:
508-653-8276
Provider Enumeration Date:
07/09/2006

Additional Information

Authorized Official

Authorized Official Last Name:
BOYKO
Authorized Official First Name:
JUDITH
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
508-653-3081

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 602137 . This is a "AETNA" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 1509 . This is a "CARE CENTRIX" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 19356 . This is a "FALLON" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 800877 . This is a "TUFTS HEALTH PLAN" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 0602035 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 120079 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 7000000004 . This is a "HARVARD PILGRIM HEALTH CA" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".




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