1184608333 NPI number — OVERLOOK VISITING NURSE ASSOCIATION, INC.

Table of content: (NPI 1184608333)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1184608333 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:
Provider Other Organization Name Type Code:
6
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:
1184608333
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/05/2015
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:
508-434-2440
Provider Business Practice Location Address Fax Number:
888-978-9808
Provider Enumeration Date:
12/01/2005

Additional Information

Authorized Official

Authorized Official Last Name:
FULLER
Authorized Official First Name:
MICHELE
Authorized Official Middle Name:
Authorized Official Title or Position:
REGIONAL ADMINISTRATOR
Authorized Official Telephone Number:
508-434-2480

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: 22D0974028 . This is a "CLIA" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 0607576 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 120443 . This is a "BLUECROSS BLUESHEILD" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".




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