=====================================================
General NPI Number Information
=====================================================
NPI Number | 1801990452
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SOUTHCOAST VISITING NURSE ASSOCIATION, INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/12/2006
-----------------------------------------------------
Last Update Date | 11/05/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 200 MILL ROAD, SUITE 120
-----------------------------------------------------
City | FAIRHAVEN
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 02719
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 508-973-3210
-----------------------------------------------------
Fax | 508-973-3215
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 200 MILL RD STE 120
-----------------------------------------------------
City | FAIRHAVEN
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 02719-5252
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 508-973-3200
-----------------------------------------------------
Fax | 508-973-3215
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | VICE PRESIDENT
-----------------------------------------------------
Name | FERNANDA JOHNSON
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 508-973-3200
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251G00000X
-----------------------------------------------------
Taxonomy Name | Community Based Hospice Care Agency
-----------------------------------------------------
License Number | 1612
-----------------------------------------------------
License Number State | RI
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 251G00000X
-----------------------------------------------------
Taxonomy Name | Community Based Hospice Care Agency
-----------------------------------------------------
License Number | 7223
-----------------------------------------------------
License Number State | MA
-----------------------------------------------------