Provider Demographics
NPI:1518247683
Name:KIT CLARK SENIOR SERVICES
Entity Type:Organization
Organization Name:KIT CLARK SENIOR SERVICES
Other - Org Name:BAY COVE HUMAN SERVICES
Other - Org Type:Other Name
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:MISS
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:L
Authorized Official - Last Name:HARRIGAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:617-619-5919
Mailing Address - Street 1:66 CANAL ST
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02114-2002
Mailing Address - Country:US
Mailing Address - Phone:617-371-3000
Mailing Address - Fax:617-371-3170
Practice Address - Street 1:42 CHARLES ST
Practice Address - Street 2:
Practice Address - City:DORCHESTER
Practice Address - State:MA
Practice Address - Zip Code:02122-1441
Practice Address - Country:US
Practice Address - Phone:617-825-5000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BAY COVE HUMAN SERVICES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-08-22
Last Update Date:2011-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110073321AMedicaid