Organization Active NPI

Village Rest Home Inc

  • Exclusive Provider Organization
  • Brockton, MA
National Provider Identifier
1104044981
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Exclusive Provider OrganizationTaxonomy code 302F00000X
Legal business name
VILLAGE REST HOME INC
Practice address
197 W Chestnut St
Brockton, MA 02301-6753
Phone
(508) 583-0040
NPI assigned
Apr 24, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Guy Marcellus
Title
Director
Phone
(508) 583-0040

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Exclusive Provider Organization 302F00000X Primary

Addresses

Primary practice location

197 W Chestnut St
Brockton, MA 02301-6753

Mailing address

30 Sinclair Rd
Brockton, MA 02302-4452

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
22D2119616Village Rest Home of Brockton197 W Chestnut St, Brockton, MA 02301Certificate of waiverSep 29, 2026

National Provider Directory

National Provider Directory

Locations

197 W Chestnut St
Brockton, MA 02301
Phone (508) 583-0040

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1177372800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1104044981",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "30 SINCLAIR RD",
            "city": "BROCKTON",
            "state": "MA",
            "postal_code": "023024452"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "197 W CHESTNUT ST",
            "city": "BROCKTON",
            "state": "MA",
            "postal_code": "023016753",
            "telephone_number": "508-583-0040"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VILLAGE REST HOME INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-24",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "MARCELLUS",
        "authorized_official_first_name": "GUY",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "508-583-0040"
    },
    "taxonomies": [
        {
            "code": "302F00000X",
            "taxonomy_group": "",
            "desc": "Exclusive Provider Organization",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "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 Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.