Healthcare Provider Details

I. General information

NPI: 1346808904
Provider Name (Legal Business Name): BAY COAST BEHAVIORAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/30/2019
Last Update Date: 05/30/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

170 PLEASANT ST STE 100
FALL RIVER MA
02721-3015
US

IV. Provider business mailing address

170 PLEASANT ST STE 100
FALL RIVER MA
02721-3015
US

V. Phone/Fax

Practice location:
  • Phone: 774-294-7522
  • Fax:
Mailing address:
  • Phone: 774-294-7522
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: TRACI MAURIE PATCH
Title or Position: EXECUTIVE ASSISTANT
Credential:
Phone: 774-294-5722