Provider Demographics
NPI:1255482139
Name:BROCKTON NEIGHBORHOOD HEALTH CENTER
Entity Type:Organization
Organization Name:BROCKTON NEIGHBORHOOD HEALTH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOCIAL WORKER
Authorized Official - Prefix:
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:
Authorized Official - Last Name:COMEAUX
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:508-559-6699
Mailing Address - Street 1:231 MAIN MAIN ST 3RD FLOOR
Mailing Address - Street 2:
Mailing Address - City:BROCKTON
Mailing Address - State:MH
Mailing Address - Zip Code:02301
Mailing Address - Country:US
Mailing Address - Phone:508-559-1567
Mailing Address - Fax:508-559-5073
Practice Address - Street 1:157 MAIN ST
Practice Address - Street 2:
Practice Address - City:BROCKTON
Practice Address - State:MA
Practice Address - Zip Code:02301-4012
Practice Address - Country:US
Practice Address - Phone:508-559-6699
Practice Address - Fax:508-559-1158
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health