1770289720 NPI number — HOSPICE OF MARTHA'S VINEYARD, 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 1770289720 NPI number — HOSPICE OF MARTHA'S VINEYARD, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HOSPICE OF MARTHA'S VINEYARD, 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:
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:
1770289720
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/01/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1748
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
VINEYARD HAVEN
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02568-0910
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
508-693-0189
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
79 BEACH ROAD, SUITE 28
Provider Second Line Business Practice Location Address:
VINEYARD HAVEN
Provider Business Practice Location Address City Name:
VINEYARD HAVEN
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02568
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
508-693-0189
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/01/2023

Additional Information

Authorized Official

Authorized Official Last Name:
WOZNIAK
Authorized Official First Name:
CATHY
Authorized Official Middle Name:
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
508-693-0189

Provider Taxonomy Codes

  • Taxonomy code: 207QH0002X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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