Provider Demographics
NPI:1245772730
Name:BROCKTON HOME HEALTH CARE AGENCY
Entity Type:Organization
Organization Name:BROCKTON HOME HEALTH CARE AGENCY
Other - Org Name:BROCKTON HHA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:PELEGE
Authorized Official - Middle Name:
Authorized Official - Last Name:MARCELLIN
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:508-219-0101
Mailing Address - Street 1:71 LEGION PKWY
Mailing Address - Street 2:SUITE 15
Mailing Address - City:BROCKTON
Mailing Address - State:MA
Mailing Address - Zip Code:02301-7225
Mailing Address - Country:US
Mailing Address - Phone:508-219-0101
Mailing Address - Fax:508-281-2030
Practice Address - Street 1:71 LEGION PKWY STE 15
Practice Address - Street 2:
Practice Address - City:BROCKTON
Practice Address - State:MA
Practice Address - Zip Code:02301-7225
Practice Address - Country:US
Practice Address - Phone:508-219-0101
Practice Address - Fax:508-281-2030
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-15
Last Update Date:2020-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health