Provider Demographics
NPI:1134126865
Name:BAY STATE COMMUNITY SERVICES, INC.
Entity Type:Organization
Organization Name:BAY STATE COMMUNITY SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:DAURICE
Authorized Official - Middle Name:
Authorized Official - Last Name:COX
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:617-471-8400
Mailing Address - Street 1:1120 HANCOCK ST
Mailing Address - Street 2:
Mailing Address - City:QUINCY
Mailing Address - State:MA
Mailing Address - Zip Code:02169-4313
Mailing Address - Country:US
Mailing Address - Phone:617-471-8400
Mailing Address - Fax:617-376-0456
Practice Address - Street 1:1120 HANCOCK ST
Practice Address - Street 2:
Practice Address - City:QUINCY
Practice Address - State:MA
Practice Address - Zip Code:02169-4313
Practice Address - Country:US
Practice Address - Phone:617-471-8400
Practice Address - Fax:617-376-0456
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-07
Last Update Date:2015-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4337261QM0801X
MA0565261QR0405X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA000000008418OtherBOSTON MEDICAL HEALTHNET
MA110027843/BMedicaid
MA110027843CMedicaid
MA110027843DMedicaid
MA613043OtherTUFTS HEALTH PLAN
MA110027843/AMedicaid
MA1003840OtherBEACON HEALTH - NHP
MA99622801OtherNETWORK HEALTH
MA110027843EMedicaid
MA1003840OtherBEACON HEALTH - NHP
MA000000008418OtherBOSTON MEDICAL HEALTHNET