Provider Demographics
NPI:1700186640
Name:SOUTHSHORE MA SNF LLC
Entity Type:Organization
Organization Name:SOUTHSHORE MA SNF LLC
Other - Org Name:SOUTHSHORE HEALTH CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LAWRENCE
Authorized Official - Middle Name:G
Authorized Official - Last Name:SANTILLI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:860-751-3900
Mailing Address - Street 1:135 SOUTH RD
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06032-2556
Mailing Address - Country:US
Mailing Address - Phone:860-751-3900
Mailing Address - Fax:860-751-3905
Practice Address - Street 1:115 NORTH AVE
Practice Address - Street 2:
Practice Address - City:ROCKLAND
Practice Address - State:MA
Practice Address - Zip Code:02370-2129
Practice Address - Country:US
Practice Address - Phone:781-878-3308
Practice Address - Fax:781-878-3321
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ATHENA HEALTH CARE SYSTEMS MA LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-10-26
Last Update Date:2023-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110087941AMedicaid
MA225215Medicare UPIN
MA110087941AMedicaid