Healthcare Provider Details

I. General information

NPI: 1588660443
Provider Name (Legal Business Name): VINEYARD NURSING ASSOCIATION, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/24/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 HOSPITAL ROAD
OAK BLUFFS MA
02557-2568
US

IV. Provider business mailing address

PO BOX 2568
OAK BLUFFS MA
02557-2568
US

V. Phone/Fax

Practice location:
  • Phone: 508-693-6184
  • Fax: 508-693-5607
Mailing address:
  • Phone: 508-693-6184
  • Fax: 508-693-5607

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number227233
License Number StateMA

VIII. Authorized Official

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