Provider Demographics
NPI:1497981591
Name:BAY COVE HUMAN SERVICES, INC
Entity Type:Organization
Organization Name:BAY COVE HUMAN SERVICES, INC
Other - Org Name:MICHAEL J GILL MH AND WELLNESS CENTER
Other - Org Type:Other Name
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:H
Authorized Official - Last Name:SPRAGUE
Authorized Official - Suffix:
Authorized Official - Credentials:MED
Authorized Official - Phone:617-371-3003
Mailing Address - Street 1:66 CANAL ST
Mailing Address - Street 2:ATTN: TERESA TARBOX
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02114-2002
Mailing Address - Country:US
Mailing Address - Phone:617-619-5919
Mailing Address - Fax:617-227-2454
Practice Address - Street 1:170 MORTON ST
Practice Address - Street 2:MJ GILL MH AND WELLNESS CENTER
Practice Address - City:JAMAICA PLAIN
Practice Address - State:MA
Practice Address - Zip Code:02130-3735
Practice Address - Country:US
Practice Address - Phone:617-619-5900
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-03
Last Update Date:2009-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA000000008416OtherNETWORK HEALTH PLAN
MA1306448Medicaid
MA796212OtherNETWORK HEALTH PLAN
MA98738301OtherNETWORK HEALTH PLAN
MA1303562Medicaid
MA1307681OtherMBHP
MA1306448OtherMBHP
MABOS2225003301OtherBLUE CROSS BLUE SHIELD OF MASS
MA000000008433OtherBMC HEALTHNET PLAN
MA1310194OtherMBHP
MA1000290OtherBHS (NHP AND FALLON)
MA1306448Medicaid