Provider Demographics
NPI:1902923998
Name:SOUTH SHORE REGIONAL VOC TCH SCHOOL
Entity type:Organization
Organization Name:SOUTH SHORE REGIONAL VOC TCH SCHOOL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF SPECIAL EDUCATION
Authorized Official - Prefix:MRS
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:
Authorized Official - Last Name:TITUS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:781-986-1785
Mailing Address - Street 1:PO BOX 540
Mailing Address - Street 2:
Mailing Address - City:RANDOLPH
Mailing Address - State:MA
Mailing Address - Zip Code:02368-0540
Mailing Address - Country:US
Mailing Address - Phone:781-986-1785
Mailing Address - Fax:781-961-6999
Practice Address - Street 1:476 WEBSTER ST
Practice Address - Street 2:
Practice Address - City:HANOVER
Practice Address - State:MA
Practice Address - Zip Code:02339-1223
Practice Address - Country:US
Practice Address - Phone:781-986-1785
Practice Address - Fax:781-961-6999
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-23
Last Update Date:2008-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1952013Medicaid