Provider Demographics
NPI:1609072404
Name:SOUTH SHORE ELDER CARE
Entity Type:Organization
Organization Name:SOUTH SHORE ELDER CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:
Authorized Official - Last Name:BELANGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:508-638-2510
Mailing Address - Street 1:PO BOX 575
Mailing Address - Street 2:
Mailing Address - City:WEST BRIDGEWATER
Mailing Address - State:MA
Mailing Address - Zip Code:02379-0575
Mailing Address - Country:US
Mailing Address - Phone:877-588-0821
Mailing Address - Fax:508-583-6219
Practice Address - Street 1:1 PEARL ST
Practice Address - Street 2:SUITE 2400
Practice Address - City:BROCKTON
Practice Address - State:MA
Practice Address - Zip Code:02301-2864
Practice Address - Country:US
Practice Address - Phone:508-897-6130
Practice Address - Fax:508-897-6135
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA052504OtherTUFTS HEALTHPLAN
MABRV03880OtherBLUE CROSS BLUE SHIELD
MA66510OtherHARVARD PILGRIM
MA9783946Medicaid
MA0402979OtherEVERCARE
MA9783946Medicaid
MABRV03880OtherBLUE CROSS BLUE SHIELD
MA0402979OtherEVERCARE