Provider Demographics
NPI:1073650396
Name:BAYSHORE HEALTH & HOMEMAKER SERVICES, INC
Entity Type:Organization
Organization Name:BAYSHORE HEALTH & HOMEMAKER SERVICES, INC
Other - Org Name:BAYSHORE HEALTH SERVICES, INC.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SUZANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:727-586-0044
Mailing Address - Street 1:PO BOX 1462
Mailing Address - Street 2:
Mailing Address - City:LARGO
Mailing Address - State:FL
Mailing Address - Zip Code:33779-1462
Mailing Address - Country:US
Mailing Address - Phone:727-586-0044
Mailing Address - Fax:727-586-0171
Practice Address - Street 1:2430 W BAY DR
Practice Address - Street 2:
Practice Address - City:LARGO
Practice Address - State:FL
Practice Address - Zip Code:33770-1933
Practice Address - Country:US
Practice Address - Phone:727-586-0044
Practice Address - Fax:727-586-0171
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-30
Last Update Date:2020-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLHHA20174095251E00000X
FLHHA299991613251E00000X
FLHHA299991207251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health