MEDICARE: VINEYARD NURSING ASSOCIATION, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251E00000X	Home Health Agency	227233	MA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1588660443
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VINEYARD NURSING ASSOCIATION, INC.

Provider Business Mailing Address
First Line	:	PO BOX 2568
Second Line	:
City	:	OAK BLUFFS
State	:	MA
Zip	:	02557-2568
Country	:	US
Telephone Number	:	508-693-6184
Fax Number	:	508-693-5607

Provider Business Practice Location Address
First Line	:	1 HOSPITAL ROAD
Second Line	:
City	:	OAK BLUFFS
State	:	MA
Zip	:	02557-2568
Country	:	US
Telephone Number	:	508-693-6184
Fax Number	:	508-693-5607

Authorized Official
Title or Position	:	PRESIDENT/CEO
Name	:	MRS. KATHLEEN F. ROSE
Credential	:	RN, MHSA
Telephone Number	:	508-693-6184

Provider Enumeration Date	:	06/24/2005
Last Update Date	:	08/22/2020

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