Provider Demographics
NPI:1497090997
Name:BAGSIYAO CORPORATION
Entity Type:Organization
Organization Name:BAGSIYAO CORPORATION
Other - Org Name:GREENBRIAR RETIREMENT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATO
Authorized Official - Prefix:MRS
Authorized Official - First Name:CORAZON
Authorized Official - Middle Name:
Authorized Official - Last Name:BAGSIYAO
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:407-883-0643
Mailing Address - Street 1:3615 MCNEIL RD
Mailing Address - Street 2:
Mailing Address - City:APOPKA
Mailing Address - State:FL
Mailing Address - Zip Code:32703-6818
Mailing Address - Country:US
Mailing Address - Phone:407-883-0643
Mailing Address - Fax:407-292-6180
Practice Address - Street 1:3615 MCNEIL RD
Practice Address - Street 2:
Practice Address - City:APOPKA
Practice Address - State:FL
Practice Address - Zip Code:32703-6818
Practice Address - Country:US
Practice Address - Phone:407-883-0643
Practice Address - Fax:407-292-6180
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-10
Last Update Date:2012-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL9202310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL142569200Medicaid
FL689265500Medicaid