1790788743 NPI number — CHICOPEE VISITING NURSE ASSOCIATION

Table of content: (NPI 1790788743)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1790788743 NPI number — CHICOPEE VISITING NURSE ASSOCIATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CHICOPEE VISITING NURSE ASSOCIATION
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:
1790788743
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/02/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2024 WESTOVER RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHICOPEE
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01022-1079
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
413-437-9862
Provider Business Mailing Address Fax Number:
413-437-9999

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2024 WESTOVER RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHICOPEE
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01022-1079
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
413-437-9862
Provider Business Practice Location Address Fax Number:
413-437-9999
Provider Enumeration Date:
05/23/2005

Additional Information

Authorized Official

Authorized Official Last Name:
COTE
Authorized Official First Name:
JUDITH
Authorized Official Middle Name:
A
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
413-437-9862

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , with the licence number:  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: 602130 . This is a "AETNA PROV. NUMBER" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 11250 . This is a "HEALTH NEW ENGLAND" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 701028 . This is a "HARVARD PILGRIM PROV#" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 120028 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 801107 . This is a "TUFTS/SEC HORIZONS" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 110024183A , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".




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