Provider Demographics
NPI:1235516469
Name:BAYSIDE RECOVERY LLC
Entity Type:Organization
Organization Name:BAYSIDE RECOVERY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM SPONSOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:GALAHER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-991-5687
Mailing Address - Street 1:440 SOLOMONS ISLAND RD N
Mailing Address - Street 2:SUITE 222
Mailing Address - City:PRINCE FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:20678-3941
Mailing Address - Country:US
Mailing Address - Phone:443-486-5680
Mailing Address - Fax:443-486-5679
Practice Address - Street 1:440 SOLOMONS ISLAND RD N
Practice Address - Street 2:SUITE 222
Practice Address - City:PRINCE FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:20678-3941
Practice Address - Country:US
Practice Address - Phone:443-486-5680
Practice Address - Fax:443-486-5679
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-27
Last Update Date:2023-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health