1609072404 NPI number — SOUTH SHORE ELDER CARE

Table of content: MS. MARYELLEN WALPOLE MSSW (NPI 1912173246)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1609072404 NPI number — SOUTH SHORE ELDER CARE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SOUTH SHORE ELDER CARE
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1609072404
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 575
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WEST BRIDGEWATER
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02379-0575
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
877-588-0821
Provider Business Mailing Address Fax Number:
508-583-6219

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1 PEARL ST
Provider Second Line Business Practice Location Address:
SUITE 2400
Provider Business Practice Location Address City Name:
BROCKTON
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02301-2864
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
508-897-6130
Provider Business Practice Location Address Fax Number:
508-897-6135
Provider Enumeration Date:
06/27/2007

Additional Information

Authorized Official

Authorized Official Last Name:
BELANGER
Authorized Official First Name:
LINDA
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTOR
Authorized Official Telephone Number:
508-638-2510

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 052504 . This is a "TUFTS HEALTHPLAN" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: BRV03880 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 66510 . This is a "HARVARD PILGRIM" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 9783946 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0402979 . This is a "EVERCARE" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".




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