1427032192 NPI number — OVERLOOK VISITING NURSE ASSOCIATION, INC.

Table of content: (NPI 1427032192)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1427032192 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:
1427032192
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 ROAD
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:
1 WEBLY ROAD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEW BEDFORD
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02745
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
508-990-8160
Provider Business Practice Location Address Fax Number:
888-978-9808
Provider Enumeration Date:
12/06/2005

Additional Information

Authorized Official

Authorized Official Last Name:
PARECE
Authorized Official First Name:
CAROL
Authorized Official Middle Name:
Authorized Official Title or Position:
REGIONAL ADMINISTRATOR
Authorized Official Telephone Number:
508-990-8160

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251E00000X , 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: 22D0974029 . This is a "CLIA" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 110024506B . This is a "MASS HEALTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 120443 . This is a "BLUE CROSS BLUE SHIELD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0607568 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".




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