Provider Demographics
NPI:1952389249
Name:SOUTHPOINTE NURSING HOME INC
Entity type:Organization
Organization Name:SOUTHPOINTE NURSING HOME INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ASSISTANT CONTROLLER
Authorized Official - Prefix:MS
Authorized Official - First Name:CATERINA
Authorized Official - Middle Name:MINA
Authorized Official - Last Name:IMBRIANO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:781-251-9001
Mailing Address - Street 1:3 ALLIED DR
Mailing Address - Street 2:SUITE 106
Mailing Address - City:DEDHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02026-6122
Mailing Address - Country:US
Mailing Address - Phone:781-251-9001
Mailing Address - Fax:781-251-9007
Practice Address - Street 1:100 AMITY ST
Practice Address - Street 2:
Practice Address - City:FALL RIVER
Practice Address - State:MA
Practice Address - Zip Code:02721-2202
Practice Address - Country:US
Practice Address - Phone:508-675-2500
Practice Address - Fax:508-675-8874
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA0955314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0921157Medicaid
MA225603Medicare ID - Type UnspecifiedMEDICARE PROVIDER #