Provider Demographics
NPI:1033429311
Name:BAYSIDE HOME CARE LLC
Entity Type:Organization
Organization Name:BAYSIDE HOME CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:M
Authorized Official - Last Name:VOGEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:989-941-0555
Mailing Address - Street 1:3323 N. GENRICH DRIVE
Mailing Address - Street 2:
Mailing Address - City:SANFORD
Mailing Address - State:MI
Mailing Address - Zip Code:48657-9569
Mailing Address - Country:US
Mailing Address - Phone:989-941-0555
Mailing Address - Fax:989-941-0670
Practice Address - Street 1:3323 N GENRICH DR
Practice Address - Street 2:
Practice Address - City:SANFORD
Practice Address - State:MI
Practice Address - Zip Code:48657-9569
Practice Address - Country:US
Practice Address - Phone:989-941-0555
Practice Address - Fax:989-941-0670
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-20
Last Update Date:2010-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No251J00000XAgenciesNursing Care