Provider Demographics
NPI:1225010192
Name:BASS RIVER HEALTHCARE ASSOCIATES, INC.
Entity Type:Organization
Organization Name:BASS RIVER HEALTHCARE ASSOCIATES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:REIDA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:508-394-1353
Mailing Address - Street 1:833 MAIN ST
Mailing Address - Street 2:ROUTE 28
Mailing Address - City:S YARMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02664-5254
Mailing Address - Country:US
Mailing Address - Phone:508-394-1353
Mailing Address - Fax:508-398-2866
Practice Address - Street 1:833 MAIN ST
Practice Address - Street 2:ROUTE 28
Practice Address - City:S YARMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02664-5254
Practice Address - Country:US
Practice Address - Phone:508-394-1353
Practice Address - Fax:508-398-2866
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-16
Last Update Date:2008-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA276111N00000X
225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAY39057OtherBCBS MA CHIRO
MAY31273OtherBCBS MA PT
MAAA56061OtherHPHC PT
MA35260OtherHPHC CHIRO
MA9783199Medicaid
MAY31273OtherBCBS MA PT
MAAA56061OtherHPHC PT