Provider Demographics
NPI:1497153001
Name:BAYSIDE HOME CARE, LLC
Entity Type:Organization
Organization Name:BAYSIDE HOME CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:
Authorized Official - Last Name:VOGEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:989-941-0555
Mailing Address - Street 1:5103 EASTMAN AVE
Mailing Address - Street 2:#100
Mailing Address - City:MIDLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48640-6785
Mailing Address - Country:US
Mailing Address - Phone:989-941-0555
Mailing Address - Fax:989-941-0463
Practice Address - Street 1:5103 EASTMAN AVE
Practice Address - Street 2:#100
Practice Address - City:MIDLAND
Practice Address - State:MI
Practice Address - Zip Code:48640-6785
Practice Address - Country:US
Practice Address - Phone:989-941-0555
Practice Address - Fax:989-941-0463
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-12
Last Update Date:2014-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No251J00000XAgenciesNursing Care