BROCKTON HOSPITAL, INC. (NPI# 1689695405) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1689695405 |
| Entity Type | Organization |
| Organization Name | BROCKTON HOSPITAL, INC. |
| Other Organization Name | SIGNATURE HEALTHCARE BROCKTON HOSPITAL |
| Practice Address |
680 Centre St Brockton MA 02302-3308 |
| Mailing Address |
680 Centre St Brockton MA 02302-3395 |
| Practice Telephone | 5089417000 |
| Mailing Telephone | 5089417555 |
| Mailing Fax Number | 5089416303 |
| Enumeration Date | 2006-07-21 |
| Last Update Date | 2020-07-20 |
| Authorized Official Name | MR. KIM HOLLON (CEO) |
| Authorized Official Telephone | 5089417004 |
| Is Organization Subpart | Y |
| Parent Organization Name | BROCKTON HOSPITAL, INC. |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 273R00000X | Psychiatric Unit | 2118 | MA | Hospital Units |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MA | 110026502B | 05 | |
| MA | 110026502C | 05 |
| Other Name | Type Code |
|---|---|
| Signature Healthcare Brockton Hospital | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1770504599 | Brockton Hospital, Inc. | General Acute Care Hospital | 680 Centre St, Brockton, MA 02302-3308 | 2006-07-21 |
| 1497776215 | Brockton Hospital, Inc. | Rehabilitation Unit | 680 Centre St, Brockton, MA 02302-3308 | 2006-07-21 |
| 1063431286 | Brockton Hospital, Inc. | General Acute Care Hospital | 680 Centre St, Brockton, MA 02302-3308 | 2006-07-19 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| System for Award Management (SAM) Entities | BROCKTON HOSPITAL, INC. | 680 Centre St, Brockton, MA 02302-3308 |
| Street Address |
680 CENTRE ST |
| City | BROCKTON |
| State | MA |
| Zip Code | 02302-3308 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1639176910 | Marcia Waitzman | Obstetrics & Gynecology | 680 Centre St, Brockton, MA 02302-3308 | 2005-07-01 |
| 1770196396 | Samantha Lipsky | Physician Assistant | 680 Centre St, Brockton, MA 02302-3308 | 2020-08-24 |
| 1760009328 | Mandi Ella Clegg | Social Worker | 680 Centre St, Brockton, MA 02302-3308 | 2020-06-30 |
| 1972128643 | Matthew Hall Wilson | Student in an Organized Health Care Education/Training Program | 680 Centre St, Brockton, MA 02302-3308 | 2020-06-09 |
| 1679198493 | Alyssa Dicosmo | Student in an Organized Health Care Education/Training Program | 680 Centre St, Brockton, MA 02302-3308 | 2020-06-09 |
| 1720603566 | Tessie Allan | Student in an Organized Health Care Education/Training Program | 680 Centre St, Brockton, MA 02302-3308 | 2020-06-08 |
| 1588289375 | Collin Rozanski | Student in an Organized Health Care Education/Training Program | 680 Centre St, Brockton, MA 02302-3308 | 2020-06-08 |
| 1619592417 | Balaji Arun Jothishankar | Student in an Organized Health Care Education/Training Program | 680 Centre St, Brockton, MA 02302-3308 | 2020-06-08 |
| 1013532845 | Angell Shi | Student in an Organized Health Care Education/Training Program | 680 Centre St, Brockton, MA 02302-3308 | 2020-06-08 |
| 1386269124 | Rebecca Yanovsky | Student in an Organized Health Care Education/Training Program | 680 Centre St, Brockton, MA 02302-3308 | 2020-06-08 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1427513373 | Miriam Monteiro | Social Worker | 688 Plain Street, Brockton, MA 02302 | 2019-02-05 |
| 1619432523 | Shirley Elefson | Social Worker | 330 Crescent Street, Brockton, MA 02302 | 2019-02-05 |
| 1578055505 | Steigmward Desir | Specialist | 472 E Ashland St, Brockton, MA 02302 | 2018-06-05 |
| 1114417797 | Katherine Douglas Van Schaik | Student in an Organized Health Care Education/Training Program | Brockton Signature Healthcare-bidmc, 680 Centre Street, Brockton, MA 02302 | 2018-05-18 |
| 1700376365 | Emmanuel Carrodeguas | Student in an Organized Health Care Education/Training Program | Brockton Hospital, 680 Centre Street, Brockton, MA 02302 | 2018-05-18 |
| 1700303856 | My Care, LLC | Home Health | 307 Field Street, Brockton, MA 02302 | 2017-08-29 |
| 1982124988 | Shavon Franks | Psychologist | 30 Downey Rd, Brockton, MA 02302 | 2017-06-21 |
| 1831629286 | Kings & Queens Empowered | Religious Nonmedical Health Care Institution | 312 Carl Ave, Brockton, MA 02302 | 2017-06-18 |
| 1487193389 | Roseline Eliezer | Licensed Practical Nurse | 17 Simeon Avenue, Brockton, MA 02302 | 2017-02-13 |
| 1184008989 | Danielle Parker | Student in an Organized Health Care Education/Training Program | 23 Grinnell Rd, Brockton, MA 02302 | 2015-07-13 |
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| Taxonomy Code | 273R00000X |
| Grouping | Hospital Units |
| Classification | Psychiatric Unit |
| In general, a distinct unit of a hospital that provides acute or long-term care to emotionally disturbed patients, including patients admitted for diagnosis and those admitted for treatment of psychiatric problems on the basis of physicians' orders and approved nursing care plans. Long-term care may include intensive supervision to the chronically mentally ill, mentally disordered or other mentally incompetent persons; (2) For Medicare, a distinct part of a general acute care hospital admitting only patients whose admission to the unit is required for active treatment, whose treatment is of an intensity that can be provided only in an inpatient hospital setting, and whose condition is described by a psychiatric principal diagnosis contained in the Third Edition of the American Psychiatric Association Diagnostic and Statistical Manual or in Chapter 5 (Mental Disorders) of the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM). The unit must furnish, through the use of qualified personnel, psychological services, social work services, psychiatric nursing, occupational therapy, and recreational therapy. The unit must maintain medical records that permit determination of the degree and intensity of treatment provided to individuals who are furnished services in the unit; the unit must meet special staff requirements in that the unit must have adequate numbers of qualified professional and supportive staff to evaluate inpatients, formulate written, individualized, comprehensive treatment plans, provide active treatment measures and engage in discharge planning. |
| Notes: Source: (1) AHA Annual Survey p. A10 1996 AHA Guide; (2) Code of Federal Regulations #42, Section 412.27. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1225399785 | Brockton Multi Services | Psychiatric Unit | 165 Quincy St, Brockton, MA 02302-2988 | 2012-05-31 |
| 1164735957 | Steward Good Samaritan Medical Center, Inc. | Psychiatric Unit | 235 N Pearl St, Brockton, MA 02301-1794 | 2010-07-21 |
| 1689763948 | Caritas Good Samaritan Medical Center-impatient Gero Psych | Psychiatric Unit | 235 N Pearl St, Brockton, MA 02301-1794 | 2006-10-12 |
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| 1700216850 | Nashoba Valley Medical Center, A Steward Family Hospital, Inc. | Psychiatric Unit | 200 Groton Rd, Ayer, MA 01432-1168 | 2013-11-26 |
| 1720369036 | Quincy Medical Center, A Steward Family Hospital, Inc. | Psychiatric Unit | 114 Whitwell St, Quincy, MA 02169-1870 | 2011-08-31 |
| 1376822676 | Morton Hospital, A Steward Family Hospital, Inc. | Psychiatric Unit | 88 Washington St, Taunton, MA 02780-2465 | 2011-08-04 |
| 1609172055 | Merrimack Valley Hospital, A Steward Family Hospital, Inc. | Psychiatric Unit | 140 Lincoln Ave, Haverhill, MA 01830-6700 | 2011-02-02 |
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| 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.