Provider Demographics
NPI:1245286152
Name:CAPE COD HEALTHCARE INC.
Entity type:Organization
Organization Name:CAPE COD HEALTHCARE INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:BAMBY
Authorized Official - Middle Name:
Authorized Official - Last Name:FORREST
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:508-523-5738
Mailing Address - Street 1:460 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HYANNIS
Mailing Address - State:MA
Mailing Address - Zip Code:02601-3653
Mailing Address - Country:US
Mailing Address - Phone:508-790-3360
Mailing Address - Fax:508-790-3304
Practice Address - Street 1:460 W MAIN ST
Practice Address - Street 2:
Practice Address - City:HYANNIS
Practice Address - State:MA
Practice Address - Zip Code:02601-3653
Practice Address - Country:US
Practice Address - Phone:508-790-3360
Practice Address - Fax:508-790-3304
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CAPE COD HEALTHCARE INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-05-25
Last Update Date:2023-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1301691Medicaid
MA4312OtherDPH LICENSE
MAY10041Medicare ID - Type Unspecified