NPIMap

Organization Active NPI

Commonwealth of Massachusetts

  • Mental Illness Community Based Residential Treatment Facility
  • Brockton, MA
National Provider Identifier
1144768045
Registry record updated Feb 10, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Illness Community Based Residential Treatment FacilityTaxonomy code 320800000X
License
LN25249 Issued in MA
Legal business name
COMMONWEALTH OF MASSACHUSETTS
Practice address
165 Quincy St
Brockton, MA 02302-2988
Phone
(508) 897-2100
Fax
(508) 586-5117
NPI assigned
Feb 10, 2017
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 10, 2017

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

Authorized official

Name
Merleen Mills, LICSW
Title
Dirtector of Emergency Services
Phone
(508) 285-9400

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Illness Community Based Residential Treatment Facility 320800000X LN25249 MA Primary

Addresses

Primary practice location

165 Quincy St
Brockton, MA 02302-2988

Mailing address

165 Quincy St.
Brockton, MA 02301
Phone (508) 897-2100

Other names 1

  • Brockton Multiservice Center Other name

National Provider Directory

National Provider Directory
Tax ID family
Brockton Multiservice Center2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

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

{
    "created_epoch": "1486684800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1486684800000",
    "number": "1144768045",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "165 QUINCY ST.",
            "city": "BROCKTON",
            "state": "MA",
            "postal_code": "02301",
            "telephone_number": "508-897-2100",
            "fax_number": "508-586-5117"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "165 QUINCY ST",
            "city": "BROCKTON",
            "state": "MA",
            "postal_code": "023022988",
            "telephone_number": "508-897-2100",
            "fax_number": "508-586-5117"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COMMONWEALTH OF MASSACHUSETTS",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-02-10",
        "last_updated": "2017-02-10",
        "status": "A",
        "authorized_official_last_name": "MILLS",
        "authorized_official_first_name": "MERLEEN",
        "authorized_official_title_or_position": "DIRTECTOR OF EMERGENCY SERVICES",
        "authorized_official_telephone_number": "508-285-9400",
        "authorized_official_credential": "LICSW"
    },
    "taxonomies": [
        {
            "code": "320800000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Mental Illness",
            "state": "MA",
            "license": "LN25249",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Brockton Multiservice Center",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

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 Feb 10, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.