Provider Demographics
NPI:1104010198
Name:BAYSIDE ASSISTED LIVING, INC.
Entity Type:Organization
Organization Name:BAYSIDE ASSISTED LIVING, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE MANAGER/DELEGATING NURSE
Authorized Official - Prefix:
Authorized Official - First Name:GINNY
Authorized Official - Middle Name:C
Authorized Official - Last Name:CARLYLE
Authorized Official - Suffix:
Authorized Official - Credentials:REGISTERED NURSE
Authorized Official - Phone:410-621-0431
Mailing Address - Street 1:7602 HEWITT FORD RD
Mailing Address - Street 2:P.O. BOX 159
Mailing Address - City:WESTOVER
Mailing Address - State:MD
Mailing Address - Zip Code:21871-4212
Mailing Address - Country:US
Mailing Address - Phone:410-621-0431
Mailing Address - Fax:
Practice Address - Street 1:7602 HEWITT FORD RD
Practice Address - Street 2:
Practice Address - City:WESTOVER
Practice Address - State:MD
Practice Address - Zip Code:21871-4212
Practice Address - Country:US
Practice Address - Phone:410-621-0431
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-01
Last Update Date:2007-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD19AL0008310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility