MEDICARE: COMMUNITY COACH, INC,

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	343900000X	Non-emergency Medical Transport (VAN)		MA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1780837427
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COMMUNITY COACH, INC,

Provider Business Mailing Address
First Line	:	25 CHRISTY DR
Second Line	:
City	:	BROCKTON
State	:	MA
Zip	:	02301-1813
Country	:	US
Telephone Number	:	508-586-0700
Fax Number	:	508-586-0705

Provider Business Practice Location Address
First Line	:	25 CHRISTY DR
Second Line	:
City	:	BROCKTON
State	:	MA
Zip	:	02301-1813
Country	:	US
Telephone Number	:	508-586-0700
Fax Number	:	508-586-0705

Authorized Official
Title or Position	:	MANAGER
Name	:	MISS MICHELLE A CASTRONOVO
Credential	:	MANAGER
Telephone Number	:	508-586-0700

Provider Enumeration Date	:	10/28/2008
Last Update Date	:	07/21/2022

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Directions to “COMMUNITY COACH, INC, ” Practice Location

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