1972508000 NPI number — MEDFORD VISITING NURSING ASSOCIATION

Table of content: (NPI 1972508000)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1972508000 NPI number — MEDFORD VISITING NURSING ASSOCIATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MEDFORD VISITING NURSING 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:
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:
1972508000
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/20/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
37 BROADWAY STE 2
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ARLINGTON
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02474-5552
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
781-643-6090
Provider Business Mailing Address Fax Number:
781-391-9877

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
37 BROADWAY STE 2
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ARLINGTON
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02474-5552
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
781-643-6090
Provider Business Practice Location Address Fax Number:
781-391-9877
Provider Enumeration Date:
06/16/2005

Additional Information

Authorized Official

Authorized Official Last Name:
GOULD
Authorized Official First Name:
JANIE
Authorized Official Middle Name:
K
Authorized Official Title or Position:
INTERIM CEO
Authorized Official Telephone Number:
781-396-2633

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , with the licence number:  N/A , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251E00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 110024197C , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 701916 . This is a "TUFTS PROVIDER NUMBER" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 0601659 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 701033 . This is a "HPHC PROVIDER NUMBER" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".




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