Provider Demographics
NPI: | 1154627578 |
---|---|
Name: | BAY COVE HUMAN SERVICES |
Entity Type: | Organization |
Organization Name: | BAY COVE HUMAN SERVICES |
Other - Org Name: | BOSTON EMERGENCY SERVICES TEAM |
Other - Org Type: | Other Name |
Authorized Official - Title/Position: | MEDICAL DIRECTOR |
Authorized Official - Prefix: | DR |
Authorized Official - First Name: | PEGGY |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | JOHNSON |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | MD |
Authorized Official - Phone: | 617-638-5795 |
Mailing Address - Street 1: | 85 E NEWTON ST |
Mailing Address - Street 2: | |
Mailing Address - City: | BOSTON |
Mailing Address - State: | MA |
Mailing Address - Zip Code: | 02118-2340 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 617-414-8336 |
Mailing Address - Fax: | 617-414-8333 |
Practice Address - Street 1: | 85 E NEWTON ST |
Practice Address - Street 2: | |
Practice Address - City: | BOSTON |
Practice Address - State: | MA |
Practice Address - Zip Code: | 02118-2340 |
Practice Address - Country: | US |
Practice Address - Phone: | 617-414-8336 |
Practice Address - Fax: | 617-414-8333 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2011-02-02 |
Last Update Date: | 2011-02-02 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 261QM0801X | Ambulatory Health Care Facilities | Clinic/Center | Mental Health (Including Community Mental Health Center) |