Provider Demographics
NPI:1770528317
Name:SOUTH SHORE MENTAL HEALTH CENTER, INC.
Entity type:Organization
Organization Name:SOUTH SHORE MENTAL HEALTH CENTER, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:MINGHUI
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:617-847-1950
Mailing Address - Street 1:1501 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:BRAINTREE
Mailing Address - State:MA
Mailing Address - Zip Code:02184-7599
Mailing Address - Country:US
Mailing Address - Phone:617-847-1950
Mailing Address - Fax:617-786-9894
Practice Address - Street 1:460 QUINCY AVE
Practice Address - Street 2:
Practice Address - City:QUINCY
Practice Address - State:MA
Practice Address - Zip Code:02169-8130
Practice Address - Country:US
Practice Address - Phone:617-847-1950
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-18
Last Update Date:2023-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA459251S00000X, 261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1300989Medicaid
MA1303155Medicaid
MA110026069Medicaid
MA1303937Medicaid
MACH9016OtherRAILROAD MEDICARE
MA1002940OtherFALLON
MA156371000OtherCMSP
MA260000415OtherRAILROAD MEDICARE
MACD2672OtherRAILROAD MEDICARE
MAM18467OtherBLUE CROSS
MA1300989Medicaid
MAM17211OtherBLUES
MA1303155Medicaid
MA305535OtherTRICARE
MA1002940OtherBEACON HEALTH STRATEGIES
MA42723OtherMAGELLAN
MA68639OtherUBH
MASOU 2223001040OtherBLUE CROSS
MA1800787Medicaid
MA156371000OtherCMSP