Provider Demographics
NPI:1770504599
Name:BROCKTON HOSPITAL, INC.
Entity Type:Organization
Organization Name:BROCKTON HOSPITAL, INC.
Other - Org Name:SIGNATURE HEALTHCARE BROCKTON HOSPITAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:HAFFEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:508-941-7000
Mailing Address - Street 1:PO BOX 847493
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02284-7493
Mailing Address - Country:US
Mailing Address - Phone:508-941-7555
Mailing Address - Fax:508-941-6303
Practice Address - Street 1:680 CENTRE ST
Practice Address - Street 2:
Practice Address - City:BROCKTON
Practice Address - State:MA
Practice Address - Zip Code:02302-3308
Practice Address - Country:US
Practice Address - Phone:508-941-7000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-21
Last Update Date:2024-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2118282N00000X
282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1002112Medicaid
MA1200283Medicaid
MAM18952OtherBCBS GROUP #
MAM18952OtherBCBS GROUP #