Healthcare Provider Details

I. General information

NPI: 1649612003
Provider Name (Legal Business Name): SOUTH SHORE ADULT DAY HEALTH CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/25/2013
Last Update Date: 07/25/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

189 BELMONT ST
BROCKTON MA
02301-5159
US

IV. Provider business mailing address

189 BELMONT ST
BROCKTON MA
02301-5159
US

V. Phone/Fax

Practice location:
  • Phone: 617-733-5159
  • Fax:
Mailing address:
  • Phone: 617-733-5159
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MS. IDELIE JEAN BAPTISTE
Title or Position: CEO
Credential:
Phone: 617-733-5159