Provider Demographics
NPI:1043697857
Name:BAYSTATE HOMECARE LLC
Entity Type:Organization
Organization Name:BAYSTATE HOMECARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:NJOROGE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:617-612-4108
Mailing Address - Street 1:695 TRUMAN HWY
Mailing Address - Street 2:SUITE B101
Mailing Address - City:HYDE PARK
Mailing Address - State:MA
Mailing Address - Zip Code:02136-3552
Mailing Address - Country:US
Mailing Address - Phone:617-612-4108
Mailing Address - Fax:844-644-5239
Practice Address - Street 1:695 TRUMAN HWY
Practice Address - Street 2:SUITE B101
Practice Address - City:HYDE PARK
Practice Address - State:MA
Practice Address - Zip Code:02136-3552
Practice Address - Country:US
Practice Address - Phone:617-612-4108
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-30
Last Update Date:2015-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health