Provider Demographics
NPI:1164593166
Name:SOUTH SHORE HOSPITAL
Entity Type:Organization
Organization Name:SOUTH SHORE HOSPITAL
Other - Org Name:HOME AND HEALTH RESOURCES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE VICE PRESIDENT COO
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:CAHILL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:781-340-8622
Mailing Address - Street 1:100 BAY STATE DRIVE
Mailing Address - Street 2:
Mailing Address - City:BRAINTREE
Mailing Address - State:MA
Mailing Address - Zip Code:02184-9060
Mailing Address - Country:US
Mailing Address - Phone:781-849-1710
Mailing Address - Fax:
Practice Address - Street 1:100 BAY STATE DRIVE
Practice Address - Street 2:
Practice Address - City:BRAINTREE
Practice Address - State:MA
Practice Address - Zip Code:02184-9060
Practice Address - Country:US
Practice Address - Phone:781-849-1710
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SOUTH SHORE HOSPITAL, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-11-13
Last Update Date:2011-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0605875Medicaid