Organization
BROCKTON NEIGHBORHOOD HEALTH CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MELVIN BENSON (CHIEF FINANCIAL OFFICER)
(508) 559-6699
Entity
Organization
Contact information
Practice address
158 PLEASANT STREET, BROCKTON, MA 02301
(508) 559-6699
(508) 559-5073
Mailing address
158 PLEASANT STREET, BROCKTON, MA 02301
(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
05
—
110028118/A
—
MA
01
—
221830
MEDICARE PART A
MA
01
—
606260
606260
MA
01
—
M18107
BLUE CROSS BLUE SHIELD
MA
01
—
M20905
MEDICARE PART B
MA
Enumeration date
03/16/2015
Last updated
05/29/2018
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