Healthcare Provider Details

I. General information

NPI: 1104937697
Provider Name (Legal Business Name): SOUTHCOAST VISITING NURSE ASSOCIATION. INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 11/05/2025
Certification Date: 11/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 MILL ROAD, SUITE 120
FAIRHAVEN MA
02719
US

IV. Provider business mailing address

200 MILL RD STE 120
FAIRHAVEN MA
02719-5252
US

V. Phone/Fax

Practice location:
  • Phone: 508-973-3210
  • Fax: 508-973-3215
Mailing address:
  • Phone: 508-973-3200
  • Fax: 508-973-3215

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number2211
License Number StateRI

VIII. Authorized Official

Name: FERNANDA JOHNSON
Title or Position: PRESIDENT/CEO
Credential: PT, DPT
Phone: 508-973-3200