BROCKTON HEALTHCARE CLINIC LLC (NPI# 1952630568) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1952630568 |
| Entity Type | Organization |
| Organization Name | BROCKTON HEALTHCARE CLINIC LLC |
| Other Organization Name | BROCKTON REGIONAL KIDNEY CENTER |
| Practice Address |
76 Campanelli Industrial Dr Brockton MA 02301-1809 |
| Practice Telephone | 5084275329 |
| Practice Fax Number | 5084275421 |
| Mailing Telephone | 5084275329 |
| Mailing Fax Number | 5084275421 |
| Enumeration Date | 2009-12-10 |
| Last Update Date | 2020-03-11 |
| Authorized Official Name | SHARI K COUSINS (SR. VP OF CLINICAL & REGULATORY) |
| Authorized Official Telephone | 9789223080 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QE0700X |
Clinic/Center Specialization: End-Stage Renal Disease (ESRD) Treatment |
Ambulatory Health Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MA | 110086580A | 05 |
| Other Name | Type Code |
|---|---|
| Brockton Regional Kidney Center | Doing Business As Name - Organization |
| Street Address |
76 CAMPANELLI INDUSTRIAL DR |
| City | BROCKTON |
| State | MA |
| Zip Code | 02301-1809 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1427001767 | Allan Lauer | Internal Medicine | 76 Campanelli Industrial Dr, Associates In Nephrology, Brockton, MA 02301-1818 | 2006-05-18 |
| 1528225745 | Ian Michael Wu | Internal Medicine | 76 Campanelli Industrial Dr, Brockton, MA 02301 | 2008-05-16 |
| 1477579795 | Daniel Leroy Bohl | Internal Medicine | 76 Campanelli Industrial Dr, Brockton, MA 02301-1809 | 2006-07-14 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1942807110 | Jenny Vulpis | Recreation Therapist | 940 Belmont St (br 135), Brockton, MA 02301 | 2020-10-01 |
| 1205444924 | Caroline Storey | Counselor | Men's Addiction Treatment Center, 10 Meadowbrook Road, Brockton, MA 02301 | 2020-07-20 |
| 1013546852 | Nuria Dos Santos Veiga | Occupational Therapist | 73 Denton St, Brockton, MA 02301 | 2020-04-03 |
| 1679113930 | Laura Ann Brondyk II | Counselor | 10 Christys Dr, Brockton, MA 02301 | 2020-01-14 |
| 1437796521 | Andrea Lopes | Developmental Therapist | 7 Goddard Road, Brockton, MA 02301 | 2019-12-08 |
| 1518420124 | Diligencehealthcare | Psychiatry & Neurology | 30-40 Westpark Street, Brockton, MA 02301 | 2019-04-10 |
| 1124530373 | Rachel Theys | Behavioral Analyst | 130 Liberty St Ste 13a, Brockton, MA 02301 | 2017-10-27 |
| 1689193369 | Anderson D Delgado | Behavior Technician | 11 Packard Way, Brockton, MA 02301 | 2017-09-14 |
| 1811415326 | Francesca Lavecchia | Clinical Neuropsychologist | Brockto Area Multi Service, Inc. 10 Christy Dr., Brockton, MA 02301 | 2017-09-05 |
| 1831615343 | Donna Marie Dugan | Counselor | South Bay Community Services, 340 Main Street - Suite 818, Worcester, MA 02301 | 2017-08-16 |
| Find all providers in zip 02301 | ||||
| Taxonomy Code | 261QE0700X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | End-Stage Renal Disease (ESRD) Treatment |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1265441224 | Bio-medical Applications of Massachusetts, Inc. | Clinic/Center | 375 Westgate Drive, Brockton, MA 02301 | 2006-08-07 |
| 1740558618 | Brockton Dialysis Center LLC | Clinic/Center | 375 Westgate Dr, Brockton, MA 02301-1818 | 2011-12-07 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1760025217 | Leominster Dialysis LLC | Clinic/Center | 20 Commercial Rd Ste 5, Leominster, MA 01453-3339 | 2019-10-28 |
| 1801448725 | Bio-medical Applications of Massachusetts Inc | Clinic/Center | 10 Galaxy Pass Ste A, Sutton, MA 01590-4838 | 2019-07-11 |
| 1023596863 | Ara-holyoke Dialysis LLC | Clinic/Center | 36 Lower Westfield Rd Unit C-153, Holyoke, MA 01040-2749 | 2018-08-03 |
| 1831603638 | Auburn Health LLC | Clinic/Center | 771 Southbridge St Ste 1, Auburn, MA 01501-1345 | 2017-12-01 |
| 1295247955 | Bio-medical Applications of Massachusetts Inc | Clinic/Center | 867 Grafton St Ste 3, Worcester, MA 01604-2052 | 2017-11-02 |
| 1356850242 | Dva Healthcare of Massachusetts Inc | Clinic/Center | 267 Shrewsbury St, Worcester, MA 01604-4623 | 2017-09-24 |
| 1942673819 | Bio-medical Applications of Massachusetts, Inc. | Clinic/Center | 216 Huttleston Ave, Fairhaven, MA 02719-1958 | 2015-11-02 |
| 1134500747 | Bio-medical Applications of Massachusetts, Inc. | Clinic/Center | 75 Newbury St, Danvers, MA 01923-1083 | 2015-06-10 |
| 1588067623 | Nxstage Boston South, LLC | Clinic/Center | 500 Providence Hwy Ste 1, Norwood, MA 02062-4960 | 2014-10-03 |
| 1164840484 | Fresenius Medical Care Cnv Marlborough, LLC | Clinic/Center | 360 Cedar Hill St Ste 3, Marlborough, MA 01752-4175 | 2014-04-03 |
| Find all providers with the same taxonomy | ||||
Please comment or provide details below to improve the information on BROCKTON HEALTHCARE CLINIC LLC.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.