1164562062 NPI number — SOUTH SHORE ARC, INC

Table of content: (NPI 1164562062)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1164562062 NPI number — SOUTH SHORE ARC, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SOUTH SHORE ARC, INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
FIRST EARLY INTERVENTION
Provider Other Organization Name Type Code:
5
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1164562062
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
371 RIVER ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NORTH WEYMOUTH
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02191-2200
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
781-335-3023
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
574 MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SOUTH WEYMOUTH
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02190-1818
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
781-331-2533
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/08/2007

Additional Information

Authorized Official

Authorized Official Last Name:
COOK
Authorized Official First Name:
DARLY
Authorized Official Middle Name:
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
781-335-3025

Provider Taxonomy Codes

  • Taxonomy code: 261QD1600X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0182128 . This is a "AETNA US HEALTHCARE" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 717088 . This is a "TUFTS HEALTH PLAN" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 00000021024 . This is a "BOSTON MEDICAL CENTER HEA" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 1801538 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 410232 . This is a "HEALTHCARE VALUE MANAGEME" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 2045129 . This is a "CIGNA" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 7509020 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 0008582 . This is a "NEIGHBORHOOD HEALTH PLAN" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 34093 . This is a "FALLON COMMUNITY HEALTH" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 603917 . This is a "HARVARD PILGRIM HEALTH CA" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: EI0007 . This is a "CLUE CROSS BLUE SHIELD" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".




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