Healthcare Provider Details

I. General information

NPI: 1669792149
Provider Name (Legal Business Name): SOUTH SHORE SUPPORT SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/07/2010
Last Update Date: 06/07/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

317 LIBBEY INDUSTRIAL PKWY UNIT B300
WEYMOUTH MA
02189-3113
US

IV. Provider business mailing address

PO BOX 890126
WEYMOUTH MA
02189-0003
US

V. Phone/Fax

Practice location:
  • Phone: 781-331-7878
  • Fax: 781-331-4882
Mailing address:
  • Phone: 781-331-7878
  • Fax: 781-331-4882

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number110075033B
License Number StateMA

VIII. Authorized Official

Name: MRS. MARY T. BURT
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 781-331-7878