Provider Demographics
NPI:1033293881
Name:BAY COVE HUMAN SERVICES, INC.
Entity Type:Organization
Organization Name:BAY COVE HUMAN SERVICES, INC.
Other - Org Name:KIT CLARK SENIOR SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO, SVP FINANCE
Authorized Official - Prefix:MRS
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:02114-9660
Mailing Address - Country:US
Mailing Address - Phone:617-371-3062
Mailing Address - Fax:617-371-3100
Practice Address - Street 1:1500 DORCHESTER AVE.
Practice Address - Street 2:
Practice Address - City:DORCHESTER
Practice Address - State:MA
Practice Address - Zip Code:02122-1327
Practice Address - Country:US
Practice Address - Phone:617-825-5000
Practice Address - Fax:617-288-5991
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BAY COVE HUMAN SREVICES, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-10-25
Last Update Date:2015-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251V00000XAgenciesVoluntary or Charitable
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1905724Medicaid
MA1905716Medicaid
MA1905732Medicaid