Provider Demographics
NPI:1578836144
Name:KIT CLARKE SENIOR SERVICES
Entity Type:Organization
Organization Name:KIT CLARKE SENIOR SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO, SVP FINANCE
Authorized Official - Prefix:
Authorized Official - First Name:KERRY
Authorized Official - Middle Name:
Authorized Official - Last Name:HORGOS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:617-371-3000
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:
Practice Address - Street 1:22 BEECHWOOD ST
Practice Address - Street 2:
Practice Address - City:DORCHESTER
Practice Address - State:MA
Practice Address - Zip Code:02121-3863
Practice Address - Country:US
Practice Address - Phone:617-371-3000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BAY COVE HUMAN SERVICES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-02-13
Last Update Date:2012-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110073321DMedicaid