Brockton Healthcare Network

Primary specialty

Mental Illness Community Based Residential Treatment FacilityTaxonomy code 320800000X

License

SB612704 Issued in OH

Legal business name

BROCKTON HEALTHCARE NETWORK

Practice address

5701 Spruce Tree Dr
Columbus, OH 43232-7751

Phone

(614) 367-6051

NPI assigned

Mar 27, 2009

Last updated

Mar 27, 2009By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mr. Augustine M. Norris, MBA(MANAGEMENT)

Title

Ceo

Phone

(614) 367-6051

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1238112000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1238112000000",
    "number": "1528200227",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5701 SPRUCE TREE DR",
            "city": "COLUMBUS",
            "state": "OH",
            "postal_code": "432327751"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5701 SPRUCE TREE DR",
            "city": "COLUMBUS",
            "state": "OH",
            "postal_code": "432327751",
            "telephone_number": "614-367-6051"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BROCKTON HEALTHCARE NETWORK",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-03-27",
        "last_updated": "2009-03-27",
        "status": "A",
        "authorized_official_last_name": "NORRIS",
        "authorized_official_first_name": "AUGUSTINE",
        "authorized_official_middle_name": "M.",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "614-367-6051",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "MBA(MANAGEMENT)"
    },
    "taxonomies": [
        {
            "code": "320800000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Mental Illness",
            "state": "OH",
            "license": "SB612704",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Tenieka Jeana Brock
• Toinette Brock
• Gabrielle Brockert
• Michael Brockfield
• Kathleen Brockman
• Ashlyn Brockway
• Maximilian David Brockwell, MD
• Matthew David Brocone, MD
• Raeshell Brod, LMT
• Jennifer Broderick, RN, BSN

• Mental Illness Community Based Residential Treatment Facility in Columbus, OH
• Providers in Columbus, OH by specialty
• Mental Illness Community Based Residential Treatment Facility in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 27, 2009; 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.