Provider Demographics
NPI:1174014823
Name:BAYSHORE HOME HEALTHCARE, INC .
Entity Type:Organization
Organization Name:BAYSHORE HOME HEALTHCARE, INC .
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:
Authorized Official - Last Name:HARLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:631-647-9020
Mailing Address - Street 1:55 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BAY SHORE
Mailing Address - State:NY
Mailing Address - Zip Code:11706-8366
Mailing Address - Country:US
Mailing Address - Phone:631-647-9020
Mailing Address - Fax:
Practice Address - Street 1:55 E MAIN ST
Practice Address - Street 2:
Practice Address - City:BAY SHORE
Practice Address - State:NY
Practice Address - Zip Code:11706-8366
Practice Address - Country:US
Practice Address - Phone:631-647-9020
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-29
Last Update Date:2018-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY04887207Medicaid