Provider Demographics
NPI:1861547010
Name:SOUTH SHORE ARC, INC
Entity type:Organization
Organization Name:SOUTH SHORE ARC, 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:
Authorized Official - Last Name:COOK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:781-335-3025
Mailing Address - Street 1:371 RIVER ST
Mailing Address - Street 2:
Mailing Address - City:NORTH WEYMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02191-2200
Mailing Address - Country:US
Mailing Address - Phone:781-335-3025
Mailing Address - Fax:781-413-2214
Practice Address - Street 1:371 RIVER ST
Practice Address - Street 2:
Practice Address - City:NORTH WEYMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02191-2200
Practice Address - Country:US
Practice Address - Phone:781-335-3025
Practice Address - Fax:781-413-2214
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1312189Medicaid