Healthcare Provider Details

I. General information

NPI: 1164562062
Provider Name (Legal Business Name): SOUTH SHORE ARC, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/08/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

574 MAIN ST
SOUTH WEYMOUTH MA
02190-1818
US

IV. Provider business mailing address

371 RIVER ST
NORTH WEYMOUTH MA
02191-2200
US

V. Phone/Fax

Practice location:
  • Phone: 781-331-2533
  • Fax:
Mailing address:
  • Phone: 781-335-3023
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD1600X
TaxonomyDevelopmental Disabilities Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MS. DARLY COOK
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 781-335-3025