Healthcare Provider Details

I. General information

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

II. Dates (important events)

Enumeration Date: 05/23/2005
Last Update Date: 03/05/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 EDGARTOWN VINEYARD HAVEN ROAD
OAK BLUFFS MA
02557
US

IV. Provider business mailing address

111 EDGARTOWN RD
VINEYARD HAVEN MA
02568-5601
US

V. Phone/Fax

Practice location:
  • Phone: 508-693-7900
  • Fax: 508-693-6669
Mailing address:
  • Phone: 508-693-7900
  • Fax: 508-693-6669

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number005601
License Number StateMA

VIII. Authorized Official

Name: MS. JULIA BURGESS
Title or Position: CEO
Credential:
Phone: 508-693-7900