MEDICARE: OVERLOOK VISITING NURSE ASSOCIATION, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251G00000X	Community Based Hospice Care Agency	77AZ	MA
2	251G00000X	Community Based Hospice Care Agency		MA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	22D1050860	OTHER	MA	CLIA
2	0611794	OTHER	MA	LICENSE
3	120443	OTHER	MA	BLUECROSS BLUESHEILD
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	110024506D	OTHER		MASS HEALTH

General Provider Information

NPI Number	:	1033176144
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OVERLOOK VISITING NURSE ASSOCIATION, INC.

Provider Business Mailing Address
First Line	:	88 MASONIC HOME RD
Second Line	:
City	:	CHARLTON
State	:	MA
Zip	:	01507-1394
Country	:	US
Telephone Number	:	800-990-7642
Fax Number	:	888-978-9808

Provider Business Practice Location Address
First Line	:	88 MASONIC HOME RD
Second Line	:
City	:	CHARLTON
State	:	MA
Zip	:	01507-1394
Country	:	US
Telephone Number	:	508-434-2200
Fax Number	:	888-978-9803

Authorized Official
Title or Position	:	HOSPICE DIRECTOR OF CLINICAL SERVIC
Name	:	CHRISTOPHER HART
Credential	:	RN
Telephone Number	:	508-434-2439

Provider Enumeration Date	:	05/01/2006
Last Update Date	:	10/07/2015

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Practice Location Address:

88 MASONIC HOME ROAD
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01507-1394

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CHARLTON, MA
01507-1394

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1255516605 — MASONIC HEALTH SYSTEM OF MASSACHUSETTS INC.
Practice Location Address:

88 MASONIC HOME RD
CHARLTON, MA
01507-1394

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1427200559 — LISA BALDASSARRE
Practice Location Address:

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CHARLTON, MA
01507-1394

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1548413941 — MARTHA E. KAUPPINEN LMT
Practice Location Address:

88 MASONIC HOME RD , GUEST SUITE 5
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Directions to “OVERLOOK VISITING NURSE ASSOCIATION, INC. ” Practice Location

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