Provider Demographics
NPI:1730182981
Name:OVERLOOK VISITING NURSE ASSOCIATION, INC.
Entity type:Organization
Organization Name:OVERLOOK VISITING NURSE ASSOCIATION, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:REGIONAL ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MICHELE
Authorized Official - Middle Name:
Authorized Official - Last Name:FULLER
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:508-434-2480
Mailing Address - Street 1:88 MASONIC HOME ROAD
Mailing Address - Street 2:
Mailing Address - City:CHARLTON
Mailing Address - State:MA
Mailing Address - Zip Code:01507-1394
Mailing Address - Country:US
Mailing Address - Phone:800-990-7642
Mailing Address - Fax:888-978-9808
Practice Address - Street 1:88 MASONIC HOME ROAD
Practice Address - Street 2:
Practice Address - City:CHARLTON
Practice Address - State:MA
Practice Address - Zip Code:01507-1394
Practice Address - Country:US
Practice Address - Phone:508-434-2200
Practice Address - Fax:888-978-9803
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-05-23
Last Update Date:2015-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA22D0974028OtherCLIA
MA0607576Medicaid
MA0607576Medicaid