Healthcare Provider Details

I. General information

NPI: 1114775442
Provider Name (Legal Business Name): BAY HUMAN SERVICES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/10/2024
Last Update Date: 05/10/2024
Certification Date: 05/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3463 DEEP RIVER RD
STANDISH MI
48658-9407
US

IV. Provider business mailing address

PO BOX 741
STANDISH MI
48658-0741
US

V. Phone/Fax

Practice location:
  • Phone: 989-846-9631
  • Fax: 989-846-6281
Mailing address:
  • Phone: 989-846-9631
  • Fax: 989-846-6281

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: MRS. NATASHA MENDOZA
Title or Position: FINANCE MANAGER
Credential:
Phone: 989-846-9631