Healthcare Provider Details

I. General information

NPI: 1376460931
Provider Name (Legal Business Name): BOSTON MEDICAL CENTER - SOUTH CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/02/2026
Last Update Date: 07/03/2026
Certification Date: 07/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

34 N PEARL ST
BROCKTON MA
02301-1708
US

IV. Provider business mailing address

1 BOSTON MEDICAL CTR PL STE 1
BOSTON MA
02118-2999
US

V. Phone/Fax

Practice location:
  • Phone: 508-408-9200
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State

VIII. Authorized Official

Name: MARK JAY HEICHMAN
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 857-310-3991