Healthcare Provider Details

I. General information

NPI: 1801990452
Provider Name (Legal Business Name): SOUTHCOAST VISITING NURSE ASSOCIATION, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/12/2006
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 TaxonomyN
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License Number1612
License Number StateRI
# 2
Primary TaxonomyY
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License Number7223
License Number StateMA

VIII. Authorized Official

Name: FERNANDA JOHNSON
Title or Position: VICE PRESIDENT
Credential:
Phone: 508-973-3200