MEDICARE: MARTHAS VINEYARD COMMUNITY SERVICES, INC DBA VISITING NURSE SERVICE

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	005601	MA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	120125	OTHER	MA	BLUE CROSS
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	704411	OTHER	MA	HARVARD PILGRIM HEALTH CA

General Provider Information

NPI Number	:	1720081912
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MARTHAS VINEYARD COMMUNITY SERVICES, INC DBA VISITING NURSE SERVICE

Provider Business Mailing Address
First Line	:	111 EDGARTOWN RD
Second Line	:
City	:	VINEYARD HAVEN
State	:	MA
Zip	:	02568-5601
Country	:	US
Telephone Number	:	508-693-7900
Fax Number	:	508-693-6669

Provider Business Practice Location Address
First Line	:	111 EDGARTOWN VINEYARD HAVEN ROAD
Second Line	:
City	:	OAK BLUFFS
State	:	MA
Zip	:	02557
Country	:	US
Telephone Number	:	508-693-7900
Fax Number	:	508-693-6669

Authorized Official
Title or Position	:	CEO
Name	:	MS. JULIA BURGESS
Credential	:
Telephone Number	:	508-693-7900

Provider Enumeration Date	:	05/23/2005
Last Update Date	:	03/05/2014

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