Provider Demographics
NPI:1417072273
Name:BAYSIDE NURSING LLC
Entity Type:Organization
Organization Name:BAYSIDE NURSING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANN MARIE
Authorized Official - Middle Name:
Authorized Official - Last Name:ST ONGE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:401-921-5995
Mailing Address - Street 1:177 AIRPORT ROAD
Mailing Address - Street 2:
Mailing Address - City:WARWICK
Mailing Address - State:RI
Mailing Address - Zip Code:02889
Mailing Address - Country:US
Mailing Address - Phone:401-921-5995
Mailing Address - Fax:401-921-5998
Practice Address - Street 1:177 AIRPORT ROAD
Practice Address - Street 2:
Practice Address - City:WARWICK
Practice Address - State:RI
Practice Address - Zip Code:02889
Practice Address - Country:US
Practice Address - Phone:401-921-5995
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-20
Last Update Date:2009-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIHN02321251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
RIBN02295Medicaid