Organization
COMMUNITY COACH, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
IGOR LIBERMAN (OWNER)
(508) 586-2222
Entity
Organization
Contact information
Practice address
25 CHRISTY DR, BROCKTON, MA 02301-1813
(781) 760-0650
Mailing address
25 CHRISTY DR, BROCKTON, MA 02301-1813
(781) 760-0650
Taxonomy
Speciality
Code
Description
License number
State
343900000X
Non-emergency Medical Transport (VAN)
Primary
—
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
110079596A
—
MA
Enumeration date
05/14/2015
Last updated
05/14/2015
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