Healthcare Provider Details

I. General information

NPI: 1952389249
Provider Name (Legal Business Name): SOUTHPOINTE NURSING HOME INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/06/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 AMITY ST
FALL RIVER MA
02721-2202
US

IV. Provider business mailing address

3 ALLIED DR SUITE 106
DEDHAM MA
02026-6122
US

V. Phone/Fax

Practice location:
  • Phone: 508-675-2500
  • Fax: 508-675-8874
Mailing address:
  • Phone: 781-251-9001
  • Fax: 781-251-9007

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number0955
License Number StateMA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier0921157
Identifier TypeMEDICAID
Identifier StateMA
Identifier Issuer

VIII. Authorized Official

Name: MS. CATERINA MINA IMBRIANO
Title or Position: ASSISTANT CONTROLLER
Credential:
Phone: 781-251-9001