Provider Demographics
NPI:1528404175
Name:BAY STATE COMMUNITY HEALTHCARE
Entity Type:Organization
Organization Name:BAY STATE COMMUNITY HEALTHCARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER/CEO
Authorized Official - Prefix:
Authorized Official - First Name:GLORIA
Authorized Official - Middle Name:
Authorized Official - Last Name:PASCUAL
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:508-283-0564
Mailing Address - Street 1:PO BOX 390002
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02139-0001
Mailing Address - Country:US
Mailing Address - Phone:617-996-0630
Mailing Address - Fax:781-558-5466
Practice Address - Street 1:34 GUILD RD
Practice Address - Street 2:
Practice Address - City:FRAMINGHAM
Practice Address - State:MA
Practice Address - Zip Code:01702-8713
Practice Address - Country:US
Practice Address - Phone:617-996-0630
Practice Address - Fax:781-558-5466
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-21
Last Update Date:2013-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA253J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253J00000XAgenciesFoster Care Agency