1730112962 NPI number — NATICK VISITING NURSE ASSN

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 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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