Provider Demographics
NPI:1639294010
Name:BROCKTON ADULT MEDICAL DAY CARE CENTER, INC
Entity Type:Organization
Organization Name:BROCKTON ADULT MEDICAL DAY CARE CENTER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:A
Authorized Official - Last Name:CASTRONOVO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:508-586-2222
Mailing Address - Street 1:25 CHRISTY DR
Mailing Address - Street 2:
Mailing Address - City:BROCKTON
Mailing Address - State:MA
Mailing Address - Zip Code:02301-1813
Mailing Address - Country:US
Mailing Address - Phone:508-586-2222
Mailing Address - Fax:508-586-2212
Practice Address - Street 1:25 CHRISTY DR
Practice Address - Street 2:
Practice Address - City:BROCKTON
Practice Address - State:MA
Practice Address - Zip Code:02301-1813
Practice Address - Country:US
Practice Address - Phone:508-586-2222
Practice Address - Fax:508-586-2212
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1949667261QA0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1949667Medicaid