Healthcare Provider Details

I. General information

NPI: 1669492542
Provider Name (Legal Business Name): SOUTHCOAST HOSPITALS GROUP, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/20/2006
Last Update Date: 07/16/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

363 HIGHLAND AVE
FALL RIVER MA
02720-3703
US

IV. Provider business mailing address

363 HIGHLAND AVE
FALL RIVER MA
02720-3703
US

V. Phone/Fax

Practice location:
  • Phone: 508-679-3131
  • Fax:
Mailing address:
  • Phone: 508-679-3131
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number3553
License Number StateMA

VII. Legacy identifiers

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

# 1
Identifier2222536201
Identifier TypeOTHER
Identifier State
Identifier IssuerBLUE CROSS
# 2
Identifier0921122
Identifier TypeMEDICAID
Identifier StateMA
Identifier Issuer
# 3
Identifier5400-3
Identifier TypeOTHER
Identifier State
Identifier IssuerBLUE CROSS RI

VIII. Authorized Official

Name: WILLIAM E GRIGG
Title or Position: EXECUTIVE VICE PRESIDENT & CFO
Credential: CPA, FHFMA
Phone: 508-961-5016