Provider Demographics
NPI:1447602024
Name:BYSTENIA SERVICES INC
Entity Type:Organization
Organization Name:BYSTENIA SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:BERTHELOT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:727-642-5448
Mailing Address - Street 1:2521 MADRID WAY S
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33712-3933
Mailing Address - Country:US
Mailing Address - Phone:727-642-5448
Mailing Address - Fax:
Practice Address - Street 1:2521 MADRID WAY S
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33712-3933
Practice Address - Country:US
Practice Address - Phone:727-642-5448
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-07
Last Update Date:2016-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL013456900Medicaid