Provider Demographics
NPI:1033176144
Name:OVERLOOK VISITING NURSE ASSOCIATION, INC.
Entity Type:Organization
Organization Name:OVERLOOK VISITING NURSE ASSOCIATION, INC.
Other - Org Name:OVERLOOK HOSPICE SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:HOSPICE DIRECTOR OF CLINICAL SERVIC
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:
Authorized Official - Last Name:HART
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:508-434-2439
Mailing Address - Street 1:88 MASONIC HOME RD
Mailing Address - Street 2:
Mailing Address - City:CHARLTON
Mailing Address - State:MA
Mailing Address - Zip Code:01507-1394
Mailing Address - Country:US
Mailing Address - Phone:800-990-7642
Mailing Address - Fax:888-978-9808
Practice Address - Street 1:88 MASONIC HOME RD
Practice Address - Street 2:
Practice Address - City:CHARLTON
Practice Address - State:MA
Practice Address - Zip Code:01507-1394
Practice Address - Country:US
Practice Address - Phone:508-434-2200
Practice Address - Fax:888-978-9803
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:OVERLOOK VISITING NURSE ASSOCIATION, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-05-01
Last Update Date:2015-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA77AZ251G00000X
MA251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA22D1050860OtherCLIA
MA0611794OtherLICENSE
MA120443OtherBLUECROSS BLUESHEILD
MA0611794Medicaid
110024506DOtherMASS HEALTH
MA120443OtherBLUECROSS BLUESHEILD