1760479166 NPI number — BAYSIDE HEALTHCARE CENTER LLC

Table of content: (NPI 1760479166)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1760479166 NPI number — BAYSIDE HEALTHCARE CENTER LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BAYSIDE HEALTHCARE CENTER LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1760479166
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/16/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
200 W UNIVERSITY AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HAMMOND
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
70401-1319
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
985-429-8800
Provider Business Mailing Address Fax Number:
985-542-0912

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3201 WALL BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GRETNA
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70056-7755
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
504-393-1515
Provider Business Practice Location Address Fax Number:
504-391-7426
Provider Enumeration Date:
09/30/2005

Additional Information

Authorized Official

Authorized Official Last Name:
LABORDE
Authorized Official First Name:
DANIEL
Authorized Official Middle Name:
J
Authorized Official Title or Position:
COO
Authorized Official Telephone Number:
985-429-8800

Provider Taxonomy Codes

  • Taxonomy code: 314000000X , with the licence number:  889 , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1510912 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com