Provider Demographics
NPI:1467726844
Name:BROCKTON REHABILITATION SERVICES CORP
Entity Type:Organization
Organization Name:BROCKTON REHABILITATION SERVICES CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:ARKADI
Authorized Official - Middle Name:
Authorized Official - Last Name:KATSNELSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:617-594-6603
Mailing Address - Street 1:425 PLEASANT ST
Mailing Address - Street 2:LOWER LEVEL
Mailing Address - City:BROCKTON
Mailing Address - State:MA
Mailing Address - Zip Code:02301-2533
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:425 PLEASANT ST
Practice Address - Street 2:LOWER LEVEL
Practice Address - City:BROCKTON
Practice Address - State:MA
Practice Address - Zip Code:02301-2533
Practice Address - Country:US
Practice Address - Phone:508-559-5135
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-01
Last Update Date:2012-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA686305S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service