Provider Demographics
NPI:1134143738
Name:VINEYARD NURSING ASSOCIATION, INC.
Entity Type:Organization
Organization Name:VINEYARD NURSING ASSOCIATION, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:TONTI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:508-693-6184
Mailing Address - Street 1:PO BOX 2568
Mailing Address - Street 2:
Mailing Address - City:OAK BLUFFS
Mailing Address - State:MA
Mailing Address - Zip Code:02557-2568
Mailing Address - Country:US
Mailing Address - Phone:508-693-6184
Mailing Address - Fax:
Practice Address - Street 1:457 A STATE ROAD
Practice Address - Street 2:
Practice Address - City:TISBURY
Practice Address - State:MA
Practice Address - Zip Code:02568
Practice Address - Country:US
Practice Address - Phone:508-693-6184
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-27
Last Update Date:2012-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0603619Medicaid
MA22-7233Medicare ID - Type Unspecified