Provider Demographics
NPI:1568422426
Name:VNA & HOSPICE OF COOLEY DICKINSON INC
Entity Type:Organization
Organization Name:VNA & HOSPICE OF COOLEY DICKINSON INC
Other - Org Name:VISITING DOCTOR
Other - Org Type:Other Name
Authorized Official - Title/Position:CEO EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:CARLA
Authorized Official - Middle Name:MARIA
Authorized Official - Last Name:BRAVEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:RN MED CHCE
Authorized Official - Phone:413-584-1060
Mailing Address - Street 1:168 INDUSTRIAL DR
Mailing Address - Street 2:
Mailing Address - City:NORTHAMPTON
Mailing Address - State:MA
Mailing Address - Zip Code:01060
Mailing Address - Country:US
Mailing Address - Phone:413-584-1060
Mailing Address - Fax:413-584-9615
Practice Address - Street 1:168 INDUSTRIAL DR
Practice Address - Street 2:
Practice Address - City:NORTHAMPTON
Practice Address - State:MA
Practice Address - Zip Code:01060
Practice Address - Country:US
Practice Address - Phone:413-584-1060
Practice Address - Fax:413-584-9615
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VIM21072Medicare ID - Type Unspecified