Provider Demographics
NPI:1295195162
Name:COMMONWEALTH CARE ALLIANCE
Entity Type:Organization
Organization Name:COMMONWEALTH CARE ALLIANCE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGISTERED NURSE
Authorized Official - Prefix:MS
Authorized Official - First Name:CATHY
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:VINCUILLA
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:508-561-0067
Mailing Address - Street 1:39 ORIOLE DR
Mailing Address - Street 2:
Mailing Address - City:NORTH ATTLEBORO
Mailing Address - State:MA
Mailing Address - Zip Code:02760-2726
Mailing Address - Country:US
Mailing Address - Phone:508-561-0067
Mailing Address - Fax:
Practice Address - Street 1:529 MAIN ST
Practice Address - Street 2:SUITE 216
Practice Address - City:CHARLESTOWN
Practice Address - State:MA
Practice Address - Zip Code:02129-1125
Practice Address - Country:US
Practice Address - Phone:617-600-3195
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-04
Last Update Date:2016-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN211669302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
MARN211669OtherRN LICENSE