Provider Demographics
NPI:1043518871
Name:BAY COVE HUMAN SERVICES, INC.
Entity type:Organization
Organization Name:BAY COVE HUMAN SERVICES, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:MS
Authorized Official - First Name:KERRY
Authorized Official - Middle Name:J
Authorized Official - Last Name:HORGOS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:617-371-3007
Mailing Address - Street 1:66 CANAL ST
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02114-2002
Mailing Address - Country:US
Mailing Address - Phone:617-371-3000
Mailing Address - Fax:617-227-2454
Practice Address - Street 1:1134 MAIN ST
Practice Address - Street 2:SOUTH WEYMOUTH NAVAL AIR STATION BUILDING 115
Practice Address - City:WEYMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02190-1559
Practice Address - Country:US
Practice Address - Phone:617-878-2558
Practice Address - Fax:617-878-2570
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-02
Last Update Date:2011-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADPH LIC #0007324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110026203BMedicaid
MA110026203DMedicaid
MA110026203FMedicaid
MA110026203CMedicaid
MA110026203HMedicaid
MA110026203EMedicaid
MA110026203AMedicaid
MA110026203GMedicaid
MA110026203IMedicaid
MA110026203CMedicaid