Organization
BROCKTON NEIGHBORHOOD HEALTH CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MELVIN BENSON (CFO)
(508) 894-3642
Entity
Organization
Contact information
Practice address
63 MAIN ST, BROCKTON, MA 02301-4042
(508) 559-6699
(508) 559-5073
Mailing address
63 MAIN ST, BROCKTON, MA 02301-4042
(508) 559-6699
(508) 559-5073
Taxonomy
Speciality
Code
Description
License number
State
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
4896
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000000021197
—
MA
01
—
0006827
NHP
MA
01
—
0192330
UNITED CARE
MA
01
—
1309927
MASSHEALTH
MA
01
—
606260
606260
MA
01
—
M18107
BLUE CROSS BLUE SHIELD
MA
Enumeration date
05/27/2006
Last updated
05/03/2018
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