Provider Demographics
NPI:1689831281
Name:BAY COVE HUMAN SERVICES INC
Entity Type:Organization
Organization Name:BAY COVE HUMAN SERVICES INC
Other - Org Name:CENTER HOUSE DAY TREATMENT
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:617-371-3000
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:617-227-2454
Practice Address - Street 1:31 BOWKER ST
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02114-2917
Practice Address - Country:US
Practice Address - Phone:617-371-3000
Practice Address - Fax:617-371-3100
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-21
Last Update Date:2008-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4189251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA000000008416OtherBMC
MA98738301OtherNETWORK HEALTH PLAN
MA1000290OtherBEACON HEALTH STRATEGIES
MA1303562Medicaid
MA1306448OtherMBHP
MA000000008416OtherBMC