Provider Demographics
NPI:1710963319
Name:HALLMARK HEALTH VISITING NURSE ASSOCIATION AND HOSPICE, INC.
Entity Type:Organization
Organization Name:HALLMARK HEALTH VISITING NURSE ASSOCIATION AND HOSPICE, INC.
Other - Org Name:HOSPICE
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:
Authorized Official - Last Name:FARRAHER-SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:MSN, MBA, RN
Authorized Official - Phone:781-338-7878
Mailing Address - Street 1:178 SAVIN ST
Mailing Address - Street 2:SUITE 300
Mailing Address - City:MALDEN
Mailing Address - State:MA
Mailing Address - Zip Code:02148-2329
Mailing Address - Country:US
Mailing Address - Phone:781-338-7800
Mailing Address - Fax:781-338-7880
Practice Address - Street 1:178 SAVIN ST
Practice Address - Street 2:SUITE 300
Practice Address - City:MALDEN
Practice Address - State:MA
Practice Address - Zip Code:02148-2329
Practice Address - Country:US
Practice Address - Phone:781-338-7800
Practice Address - Fax:781-338-7880
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-16
Last Update Date:2012-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAN/A251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA22-1537AMedicare ID - Type Unspecified