MEDICARE: VISITING NURSE AT HIGHLAND, 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	311Z00000X	Custodial Care Facility	0787	MA
2	314000000X	Skilled Nursing Facility	0787	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	:	1861481681
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VISITING NURSE AT HIGHLAND, INC

Provider Business Mailing Address
First Line	:	186 HIGHLAND AVE
Second Line	:
City	:	SOMERVILLE
State	:	MA
Zip	:	02143-1507
Country	:	US
Telephone Number	:	617-776-4420
Fax Number	:	617-629-7926

Provider Business Practice Location Address
First Line	:	186 HIGHLAND AVE
Second Line	:
City	:	SOMERVILLE
State	:	MA
Zip	:	02143-1507
Country	:	US
Telephone Number	:	617-776-4420
Fax Number	:	617-629-7926

Authorized Official
Title or Position	:	PRESIDENT
Name	:	LINDA S. CORNELL
Credential	:	RN
Telephone Number	:	617-776-9800

Provider Enumeration Date	:	10/14/2005
Last Update Date	:	10/26/2020

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