- Enrollment id
- O20241008002192
- Enrollment state
- MA
- Provider type code
- 00-09
- Provider type text
- PART A PROVIDER - HOSPITAL
- Npi
- 1871329110
- Multiple npi flag
- Y
- Ccn
- 220111
- Associate id
- 2163953605
- Organization name
- BOSTON MEDICAL CENTER - SOUTH CORPORATION
- Incorporation date
- 2024-08-14
- Incorporation state
- MA
- Organization type structure
- CORPORATION
- Proprietary nonprofit
- N
- Address line 1
- 235 NORTH PEARL STREET
- City
- BROCKTON
- State
- MA
- Zip code
- 23011794
- Practice location type
- MAIN/PRIMARY HOSPITAL LOCATION
- Subgroup - general
- N
- Subgroup - acute care
- Y
- Subgroup - alcohol drug
- N
- Subgroup - childrens
- N
- Subgroup - long-term
- N
- Subgroup - psychiatric
- N
- Subgroup - rehabilitation
- N
- Subgroup - short-term
- N
- Subgroup - swing-bed approved
- N
- Subgroup - psychiatric unit
- N
- Subgroup - rehabilitation unit
- N
- Subgroup - specialty hospital
- N
- Subgroup - other
- N
- Reh conversion flag
- N