Provider Demographics
NPI:1447306089
Name:THE ARC OF THE SOUTH SHORE, INC.
Entity type:Organization
Organization Name:THE ARC OF THE SOUTH SHORE, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:DARYL
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:COOK-IVAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:781-335-3023
Mailing Address - Street 1:20 POND PARK RD.
Mailing Address - Street 2:
Mailing Address - City:HINGHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02043
Mailing Address - Country:US
Mailing Address - Phone:781-335-3023
Mailing Address - Fax:781-331-6021
Practice Address - Street 1:20 POND PARK RD.
Practice Address - Street 2:
Practice Address - City:HINGHAM
Practice Address - State:MA
Practice Address - Zip Code:02043
Practice Address - Country:US
Practice Address - Phone:781-335-3023
Practice Address - Fax:781-331-6021
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-26
Last Update Date:2019-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251X00000XAgenciesSupports Brokerage
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110027983DMedicaid
MA1901656Medicaid