Healthcare Provider Details

I. General information

NPI: 1134126865
Provider Name (Legal Business Name): BAY STATE COMMUNITY SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/07/2005
Last Update Date: 06/18/2025
Certification Date: 06/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1120 HANCOCK ST
QUINCY MA
02169-4313
US

IV. Provider business mailing address

1120 HANCOCK ST
QUINCY MA
02169-4313
US

V. Phone/Fax

Practice location:
  • Phone: 617-471-8400
  • Fax: 617-376-0456
Mailing address:
  • Phone: 617-471-8400
  • Fax: 617-376-0456

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number0565
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number4337
License Number StateMA

VIII. Authorized Official

Name: DR. DAURICE COX
Title or Position: CEO
Credential:
Phone: 617-471-8400