Provider Demographics
NPI:1447378823
Name:CITY OF BROCKTON
Entity Type:Organization
Organization Name:CITY OF BROCKTON
Other - Org Name:BROCKTON PUBLIC SCHOOLS
Other - Org Type:Other Name
Authorized Official - Title/Position:SPECIAL EDUCATION DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KAY
Authorized Official - Middle Name:
Authorized Official - Last Name:SEALE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:508-580-7575
Mailing Address - Street 1:43 CRESCENT ST
Mailing Address - Street 2:
Mailing Address - City:BROCKTON
Mailing Address - State:MA
Mailing Address - Zip Code:02301-4311
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:43 CRESCENT ST
Practice Address - Street 2:
Practice Address - City:BROCKTON
Practice Address - State:MA
Practice Address - Zip Code:02301-4311
Practice Address - Country:US
Practice Address - Phone:508-580-7575
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1951343Medicaid