NPIMap

Organization Active NPI

South Bay Mental Health

  • Exclusive Provider Organization
  • Brockton, MA
National Provider Identifier
1588093108
Registry record updated Nov 4, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Exclusive Provider OrganizationTaxonomy code 302F00000X
Legal business name
SOUTH BAY MENTAL HEALTH
Practice address
1115 W Chestnut St
Brockton, MA 02301-7501
Phone
(508) 580-4691
NPI assigned
Nov 4, 2013
Last updated
Nov 4, 2013By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 4, 2013

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Ms. Shawntae Nicole Grace
Title
Intake Liason
Phone
(508) 863-1584

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Exclusive Provider Organization 302F00000X NU Primary

Addresses

Primary practice location

1115 W Chestnut St
Brockton, MA 02301-7501

Mailing address

1115 W Chestnut St
Brockton, MA 02301-7501
Phone (508) 580-4691

National Provider Directory

National Provider Directory
Tax ID family
South Bay Mental Health18 organizations share this tax ID, including this one

Other organizations with this tax ID 17

Organizations that report the same tax identification number in the National Provider Directory.

View all 17

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1383523200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1383523200000",
    "number": "1588093108",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1115 W CHESTNUT ST",
            "city": "BROCKTON",
            "state": "MA",
            "postal_code": "023017501",
            "telephone_number": "508-580-4691"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1115 W CHESTNUT ST",
            "city": "BROCKTON",
            "state": "MA",
            "postal_code": "023017501",
            "telephone_number": "508-580-4691"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTH BAY MENTAL HEALTH",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-11-04",
        "last_updated": "2013-11-04",
        "status": "A",
        "authorized_official_last_name": "GRACE",
        "authorized_official_first_name": "SHAWNTAE",
        "authorized_official_middle_name": "NICOLE",
        "authorized_official_title_or_position": "INTAKE LIASON",
        "authorized_official_telephone_number": "508-863-1584",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "302F00000X",
            "taxonomy_group": "",
            "desc": "Exclusive Provider Organization",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Brockton, MA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 4, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.