Healthcare Provider Details

I. General information

NPI: 1326429820
Provider Name (Legal Business Name): BROCKTON ADULT MEDICAL DAY CARE CENTER II, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/11/2015
Last Update Date: 06/11/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 CITY HALL PLZ
BROCKTON MA
02301-4341
US

IV. Provider business mailing address

55 CITY HALL PLZ
BROCKTON MA
02301-4341
US

V. Phone/Fax

Practice location:
  • Phone: 508-586-2222
  • Fax: 508-586-2212
Mailing address:
  • Phone: 508-586-2222
  • Fax: 508-586-2212

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MICHELLE BODOIN
Title or Position: ADMINISTRATOR
Credential: PD
Phone: 508-586-2222