1700871092 NPI number — HOLYOKE 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 1700871092 NPI number — HOLYOKE VISITING NURSE ASSOCIATION, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HOLYOKE 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:
1700871092
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/09/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
575 BEECH STREET
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HOLYOKE
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01040-2223
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
413-534-5691
Provider Business Mailing Address Fax Number:
413-538-7168

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10 HOSPITAL DRIVE
Provider Second Line Business Practice Location Address:
SUITE 201
Provider Business Practice Location Address City Name:
HOLYOKE
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01040-6603
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
413-534-5691
Provider Business Practice Location Address Fax Number:
413-538-7168
Provider Enumeration Date:
09/13/2005

Additional Information

Authorized Official

Authorized Official Last Name:
BOSS
Authorized Official First Name:
PAULA
Authorized Official Middle Name:
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
413-534-5691

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: 120015 . This is a "BLUE SHIELD" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 0602302 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".




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