MEDICARE: BROCKTON HOME HEALTH AFC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251E00000X	Home Health Agency

General Provider Information

NPI Number	:	1063219996
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BROCKTON HOME HEALTH AFC

Provider Business Mailing Address
First Line	:	71 LEGION PKWY STE 15
Second Line	:
City	:	BROCKTON
State	:	MA
Zip	:	02301-7225
Country	:	US
Telephone Number	:	508-219-0101
Fax Number	:	508-281-2030

Provider Business Practice Location Address
First Line	:	71 LEGION PKWY STE 15
Second Line	:
City	:	BROCKTON
State	:	MA
Zip	:	02301-7225
Country	:	US
Telephone Number	:	508-219-0101
Fax Number	:	508-281-2030

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. PELEGE MARCELLIN
Credential	:
Telephone Number	:	508-219-0101

Provider Enumeration Date	:	02/27/2025
Last Update Date	:	03/08/2025

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