Provider Demographics
NPI:1871606194
Name:VISITING NURSE ASSOCIATION & HOSPICE OF NORTHERN BERKSHIRE, INC.
Entity type:Organization
Organization Name:VISITING NURSE ASSOCIATION & HOSPICE OF NORTHERN BERKSHIRE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:WENDY
Authorized Official - Middle Name:A
Authorized Official - Last Name:DUBIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:413-664-4536
Mailing Address - Street 1:P.O. BOX 869
Mailing Address - Street 2:99 HOSPITAL AVENUE, SUITE 100
Mailing Address - City:NORTH ADAMS
Mailing Address - State:MA
Mailing Address - Zip Code:01247
Mailing Address - Country:US
Mailing Address - Phone:413-664-4536
Mailing Address - Fax:413-662-6815
Practice Address - Street 1:99 HOSPITAL AVENUE
Practice Address - Street 2:
Practice Address - City:NORTH ADAMS
Practice Address - State:MA
Practice Address - Zip Code:01247
Practice Address - Country:US
Practice Address - Phone:413-664-4536
Practice Address - Fax:413-662-6815
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-17
Last Update Date:2012-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA7FYJ251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0607096Medicaid
MA221549AMedicare ID - Type UnspecifiedHOSPICE MEDICARE NUMBER