Brockton Manor, Inc.

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

0797 Issued in MA

Legal business name

BROCKTON MANOR, INC.

Practice address

41 Libby St
Brockton, MA 02302-2949

Phone

(508) 588-1450

Fax

(508) 583-2415

NPI assigned

May 20, 2006

Organization subpart

No

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

Authorized official

Name

Kelly R Thomas

Title

Secretary

Phone

(615) 905-5200

Specialties & licenses 1

Addresses

Other names 1

• Regent Park Manor and Rehab Doing business as

Locations

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

{
    "created_epoch": "1148083200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1469145600000",
    "number": "1891749222",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 10",
            "city": "PARSONS",
            "state": "TN",
            "postal_code": "383630010",
            "telephone_number": "731-847-6343",
            "fax_number": "731-847-4200"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "41 LIBBY ST",
            "city": "BROCKTON",
            "state": "MA",
            "postal_code": "023022949",
            "telephone_number": "508-588-1450",
            "fax_number": "508-583-2415"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BROCKTON MANOR, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-20",
        "last_updated": "2016-07-22",
        "status": "A",
        "authorized_official_last_name": "THOMAS",
        "authorized_official_first_name": "KELLY",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "SECRETARY",
        "authorized_official_telephone_number": "615-905-5200"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "MA",
            "license": "0797",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Regent Park Manor and Rehab",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Skilled Nursing Facility in Brockton, MA
• Providers in Brockton, MA by specialty
• Skilled Nursing Facility in Massachusetts

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 22, 2016; 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.