Provider Demographics
NPI:1972508000
Name:MEDFORD VISITING NURSING ASSOCIATION
Entity Type:Organization
Organization Name:MEDFORD VISITING NURSING ASSOCIATION
Other - Org Name:GREATER MEDFORD VISITING NURSING ASSOCIATION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:INTERIM CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:JANIE
Authorized Official - Middle Name:K
Authorized Official - Last Name:GOULD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:781-396-2633
Mailing Address - Street 1:37 BROADWAY STE 2
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:02474-5552
Mailing Address - Country:US
Mailing Address - Phone:781-643-6090
Mailing Address - Fax:781-391-9877
Practice Address - Street 1:37 BROADWAY STE 2
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:MA
Practice Address - Zip Code:02474-5552
Practice Address - Country:US
Practice Address - Phone:781-643-6090
Practice Address - Fax:781-391-9877
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-16
Last Update Date:2021-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAN/A251E00000X
251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110024197CMedicaid
MA701916OtherTUFTS PROVIDER NUMBER
MA0601659Medicaid
MA701033OtherHPHC PROVIDER NUMBER