NPIMap

Organization Active NPI

Southcoast Visiting Nurse Association. Inc

  • Home Health Agency
  • Fairhaven, MA
National Provider Identifier
1104937697
Registry record updated Nov 5, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Home Health AgencyTaxonomy code 251E00000X
License
2211 Issued in RI
Legal business name
SOUTHCOAST VISITING NURSE ASSOCIATION. INC
Practice address
200 Mill Road, Suite 120
Fairhaven, MA 02719
Phone
(508) 973-3210
Fax
(508) 973-3215
NPI assigned
Aug 31, 2006
Last updated
Nov 5, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 5, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Fernanda Johnson, PT, DPT
Title
President/Ceo
Phone
(508) 973-3200

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Home Health Agency 251E00000X 2211 RI Primary

Addresses

Primary practice location

200 Mill Road, Suite 120
Fairhaven, MA 02719

Mailing address

200 Mill Rd Ste 120
Fairhaven, MA 02719-5252
Phone (508) 973-3200

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20071121000486 MA Part A Provider - Home Health Agency 5193637189 Practice locations: Fairhaven, MA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1104937697. Details of each certification follow.

Home health agency certification: CCN 227101

Legal name
SOUTHCOAST VISITING NURSE ASSOCIATION, INC
Certification status
Active
Provider type (POS)
Home health agency
Participating since
Jul 1, 1966
Last certification
Oct 7, 2019
Ownership / control type
Non-Profit
Organization structure
CorporationNon-profit
Incorporated
Jan 1, 1925 in MA
Enrollment address
200 Mill Road
Fairhaven, MA 02719-5252
HHA Branch

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Care Compare: Home health agency

Medicare Care Compare
Listed as
Southcoast Visiting Nurse Association IncCCN 227101 · All quality measures
Overall star rating
3.5 of 5
Ownership
Non-Profit
Certified
Jul 1, 1966
Medicare certification status
ActiveFrom the Provider of Services file
Services
Nursing, Medical social, Home health aide, Physical therapy, Speech pathology, Occupational therapy

National Provider Directory

National Provider Directory
Tax ID family
Hospice and Palliative Care2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

200 Mill Rd
Ste 120
Fairhaven, MA 02719
Phone (508) 973-3200

Ownership & related parties

All disclosed owners & managing parties 10

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Patricia Buiocchi Individual Corporate Officer Apr 1, 2022
Miguel B Brillantes Individual Corporate Director Apr 1, 2022
Jeffrey Lawrence Individual Corporate Director Apr 1, 2022
Renee Clark Individual Corporate Director Apr 1, 2022
Rayford Kruger Individual Corporate Director Apr 1, 2022
Curtis Mello Individual Corporate Director Apr 1, 2022
Paul Velho Individual Corporate DirectorFinance Manager May 1, 2022
W-2 Managing Employee May 1, 2022
Wade Broughman Individual Corporate Director Apr 1, 2022
Linda Fagioli Individual Operational/Managerial Control May 1, 2022
Chandra S Reddivari Individual Corporate Director Apr 1, 2022

Owners & managing parties with NPI records 4

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

Practitioners & affiliated clinicians

Affiliated clinicians 239

Clinicians who list this facility as an affiliation in Medicare Care Compare.

View all 239

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1156982400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1762300800000",
    "number": "1104937697",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "200 MILL RD STE 120",
            "city": "FAIRHAVEN",
            "state": "MA",
            "postal_code": "027195252",
            "telephone_number": "508-973-3200",
            "fax_number": "508-973-3215"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 MILL ROAD, SUITE 120",
            "city": "FAIRHAVEN",
            "state": "MA",
            "postal_code": "02719",
            "telephone_number": "508-973-3210",
            "fax_number": "508-973-3215"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHCOAST VISITING NURSE ASSOCIATION. INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-31",
        "last_updated": "2025-11-05",
        "certification_date": "2025-11-05",
        "status": "A",
        "authorized_official_last_name": "JOHNSON",
        "authorized_official_first_name": "FERNANDA",
        "authorized_official_title_or_position": "PRESIDENT/CEO",
        "authorized_official_telephone_number": "508-973-3200",
        "authorized_official_credential": "PT, DPT"
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": "RI",
            "license": "2211",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fairhaven, MA

Sources for this page

Verify at the official NPI Registry.