Provider Demographics
NPI:1588660443
Name:VINEYARD NURSING ASSOCIATION, INC.
Entity type:Organization
Organization Name:VINEYARD NURSING ASSOCIATION, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:F
Authorized Official - Last Name:ROSE
Authorized Official - Suffix:
Authorized Official - Credentials:RN, MHSA
Authorized Official - Phone:508-693-6184
Mailing Address - Street 1:PO BOX 2568
Mailing Address - Street 2:
Mailing Address - City:OAK BLUFFS
Mailing Address - State:MA
Mailing Address - Zip Code:02557-2568
Mailing Address - Country:US
Mailing Address - Phone:508-693-6184
Mailing Address - Fax:508-693-5607
Practice Address - Street 1:1 HOSPITAL ROAD
Practice Address - Street 2:
Practice Address - City:OAK BLUFFS
Practice Address - State:MA
Practice Address - Zip Code:02557-2568
Practice Address - Country:US
Practice Address - Phone:508-693-6184
Practice Address - Fax:508-693-5607
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA227233251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0603619Medicaid
MA0603619Medicaid