Provider Demographics
NPI:1790053270
Name:BAY AREA SUBSTANCE EDUCATION SERVICES
Entity Type:Organization
Organization Name:BAY AREA SUBSTANCE EDUCATION SERVICES
Other - Org Name:BASES RECOVERY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PROGRAM DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CELIA
Authorized Official - Middle Name:
Authorized Official - Last Name:PARTIDA KELLY
Authorized Official - Suffix:
Authorized Official - Credentials:MA,LPC,CAADC,CTP,
Authorized Official - Phone:231-547-1144
Mailing Address - Street 1:101 M 66 N
Mailing Address - Street 2:
Mailing Address - City:CHARLEVOIX
Mailing Address - State:MI
Mailing Address - Zip Code:49720-9338
Mailing Address - Country:US
Mailing Address - Phone:231-547-1144
Mailing Address - Fax:231-547-4970
Practice Address - Street 1:101 M 66 N
Practice Address - Street 2:
Practice Address - City:CHARLEVOIX
Practice Address - State:MI
Practice Address - Zip Code:49720-9338
Practice Address - Country:US
Practice Address - Phone:231-547-1144
Practice Address - Fax:231-547-4970
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-12
Last Update Date:2023-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YA0400X, 101YM0800X
MI150013251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIMNPC20131030OtherMCLAREN HEALTH PLAN, MCLAREN MEDICAID, MCLAREN HMO, MCLAREN HEALTH ADVANTAGE
MIOA50082OtherBCBSM MENTAL HEALTH AND SUBSTANCE ABUSE
MIMIS601220445OtherMAGELLAN
MI383SYS0617-COtherHUMANA BEHAVIORAL HEALTH
MIMIS601220444OtherMAGELLAN
MICOUN18-99599OtherMDHHS
MIMIS601220443OtherMAGELLAN
MI20151209439760Medicaid
MIOA50082OtherBLUE CROSS BLUE SHIELD, TRADITIONAL (10) PAR, PPO TRUST (55)
MI000722974OtherOPTUM