Provider Demographics
NPI:1659398626
Name:SOUTHCOAST HOSPITALS GROUP, INC
Entity Type:Organization
Organization Name:SOUTHCOAST HOSPITALS GROUP, INC
Other - Org Name:SOUTHCOAST HOME CARE
Other - Org Type:Other Name
Authorized Official - Title/Position:EXECUTIVE VICE PRESIDENT & CFO
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:E
Authorized Official - Last Name:GRIGG
Authorized Official - Suffix:
Authorized Official - Credentials:CPA,FHFMA
Authorized Official - Phone:508-961-5016
Mailing Address - Street 1:200 MILL RD
Mailing Address - Street 2:
Mailing Address - City:FAIRHAVEN
Mailing Address - State:MA
Mailing Address - Zip Code:02719-5252
Mailing Address - Country:US
Mailing Address - Phone:508-984-0200
Mailing Address - Fax:508-984-0217
Practice Address - Street 1:200 MILL RD
Practice Address - Street 2:
Practice Address - City:FAIRHAVEN
Practice Address - State:MA
Practice Address - Zip Code:02719-5252
Practice Address - Country:US
Practice Address - Phone:508-984-0200
Practice Address - Fax:508-984-0217
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SOUTHCOAST HEALTH SYSTEM, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-07-16
Last Update Date:2009-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAV113251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
0014272OtherNEIGHBORHOOD HLTH PLAN
702122OtherHARVARD PILGRIM
120194OtherBLUE CROSS
801326OtherTUFTS
6000002OtherUNITED HEALTH PLANS
000000022409OtherBMC HEALTHNET
6300655OtherAETNA
MA0612642Medicaid
602684300OtherUS DPT OF LABOR
227194Medicare Oscar/Certification