Provider Demographics
NPI:1821159880
Name:FAMILY AND COMMUNITY RESOURCES, INC.
Entity Type:Organization
Organization Name:FAMILY AND COMMUNITY RESOURCES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CLAUDETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:KELLY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:508-583-6498
Mailing Address - Street 1:18 NEWTON ST
Mailing Address - Street 2:
Mailing Address - City:BROCKTON
Mailing Address - State:MA
Mailing Address - Zip Code:02301-5115
Mailing Address - Country:US
Mailing Address - Phone:508-583-6498
Mailing Address - Fax:508-583-3775
Practice Address - Street 1:18 NEWTON ST
Practice Address - Street 2:
Practice Address - City:BROCKTON
Practice Address - State:MA
Practice Address - Zip Code:02301-5115
Practice Address - Country:US
Practice Address - Phone:508-583-6498
Practice Address - Fax:508-583-3775
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-13
Last Update Date:2020-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4695 DPH251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD1302981OtherMBHP ID #
MA95074701OtherNETWORK HEALTH
MA1302981Medicaid
MA725287OtherTUFTS ID NUMBER
MAM18532OtherBCBS ID NUMBER
MA1003790OtherBEACON HEALTH ID #
MA1302981Medicaid