Provider Demographics
NPI:1043213275
Name:BROCKTON VISITING NURSE ASSOCIATION
Entity Type:Organization
Organization Name:BROCKTON VISITING NURSE ASSOCIATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BEVERLY
Authorized Official - Middle Name:
Authorized Official - Last Name:PAVASARIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:508-894-5284
Mailing Address - Street 1:500 BELMONT ST
Mailing Address - Street 2:STE 200
Mailing Address - City:BROCKTON
Mailing Address - State:MA
Mailing Address - Zip Code:02301-4985
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:500 BELMONT ST
Practice Address - Street 2:STE 200
Practice Address - City:BROCKTON
Practice Address - State:MA
Practice Address - Zip Code:02301-4985
Practice Address - Country:US
Practice Address - Phone:508-587-2121
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-05-23
Last Update Date:2010-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA227006251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA000000005536OtherBMC HEALTHNET PROVIDER #
MA120L18OtherBCBSMA PROVIDER #
MA60-00143OtherUNITED HEALTCARE PROV #
MA700045OtherHARVARD HEATLHCARE PROV #
MA0007361OtherNHP PROVIDER #
MA0600717Medicaid
MA800555OtherTUFTS PROVIDER #
MA0409668OtherCIGNA HEALTH PLAN PROV #
4506370OtherAETNA PROVIDER #
MA120L18OtherBCBSMA PROVIDER #