Active NPI
Alexandra Marie Gordon, ON CALL RECOVERY COA
- Substance Abuse Rehabilitation Facility
- Brockton, MA
National Provider Identifier
1063930337
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Substance Abuse Rehabilitation Facility
- Practice address
- 10 Meadowbrook Rd
Brockton, MA 02301-7122 - Phone
- (774) 330-8944
- Fax
- (508) 408-6192
- NPI assigned
- Sep 6, 2017
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Substance Abuse Rehabilitation Facility | 324500000X | MA | Primary |
Addresses
Primary practice location
10 Meadowbrook Rd
Brockton, MA 02301-7122
Mailing address
10 Meadowbrook Rd
Brockton, MA 02301-7122
Phone (774) 330-8944
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1518996354 | Medicaid | MA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1504656000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1658361600000",
"number": "1063930337",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "10 MEADOWBROOK RD",
"city": "BROCKTON",
"state": "MA",
"postal_code": "023017122",
"telephone_number": "774-330-8944",
"fax_number": "508-408-6192"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "10 MEADOWBROOK RD",
"city": "BROCKTON",
"state": "MA",
"postal_code": "023017122",
"telephone_number": "774-330-8944",
"fax_number": "508-408-6192"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GORDON",
"first_name": "ALEXANDRA",
"middle_name": "MARIE",
"credential": "ON CALL RECOVERY COA",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2017-09-06",
"last_updated": "2022-07-21",
"status": "A"
},
"taxonomies": [
{
"code": "324500000X",
"taxonomy_group": "",
"desc": "Substance Abuse Rehabilitation Facility",
"state": "MA",
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1518996354",
"state": "MA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Brockton, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.