Provider Demographics
NPI:1649612003
Name:SOUTH SHORE ADULT DAY HEALTH CENTER LLC
Entity type:Organization
Organization Name:SOUTH SHORE ADULT DAY HEALTH CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:IDELIE
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:BAPTISTE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:617-733-5159
Mailing Address - Street 1:189 BELMONT ST
Mailing Address - Street 2:
Mailing Address - City:BROCKTON
Mailing Address - State:MA
Mailing Address - Zip Code:02301-5159
Mailing Address - Country:US
Mailing Address - Phone:617-733-5159
Mailing Address - Fax:
Practice Address - Street 1:189 BELMONT ST
Practice Address - Street 2:
Practice Address - City:BROCKTON
Practice Address - State:MA
Practice Address - Zip Code:02301-5159
Practice Address - Country:US
Practice Address - Phone:617-733-5159
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-25
Last Update Date:2013-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care