Provider Demographics
NPI:1669792149
Name:SOUTH SHORE SUPPORT SERVICES
Entity type:Organization
Organization Name:SOUTH SHORE SUPPORT SERVICES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:T
Authorized Official - Last Name:BURT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:781-331-7878
Mailing Address - Street 1:PO BOX 890126
Mailing Address - Street 2:
Mailing Address - City:WEYMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02189-0003
Mailing Address - Country:US
Mailing Address - Phone:781-331-7878
Mailing Address - Fax:781-331-4882
Practice Address - Street 1:317 LIBBEY INDUSTRIAL PKWY
Practice Address - Street 2:UNIT B300
Practice Address - City:WEYMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02189-3113
Practice Address - Country:US
Practice Address - Phone:781-331-7878
Practice Address - Fax:781-331-4882
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-07
Last Update Date:2010-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA110075033B261QA0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA61752828Medicaid