Provider Demographics
NPI:1407816465
Name:BAYFRONT HMA HOME HEALTH LLC
Entity Type:Organization
Organization Name:BAYFRONT HMA HOME HEALTH LLC
Other - Org Name:BAYFRONT HEALTH ST PETERSBURG - HOME CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SECRETARY / TREASURER
Authorized Official - Prefix:
Authorized Official - First Name:NICHOLAS
Authorized Official - Middle Name:
Authorized Official - Last Name:GACHASSIN
Authorized Official - Suffix:III
Authorized Official - Credentials:
Authorized Official - Phone:337-233-1307
Mailing Address - Street 1:PO BOX 51266
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70505-1266
Mailing Address - Country:US
Mailing Address - Phone:337-233-1307
Mailing Address - Fax:337-443-4154
Practice Address - Street 1:603 7TH ST S
Practice Address - Street 2:STE 430
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33701-4719
Practice Address - Country:US
Practice Address - Phone:727-350-5875
Practice Address - Fax:727-803-6837
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-24
Last Update Date:2022-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL29999164251E00000X
FL299991664251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL10-7742Medicare ID - Type UnspecifiedHOME HEALTH PROVIDER NUMB