Provider Demographics
NPI:1518185818
Name:BAYSIDE FAMILY HEALTHCARE, INC.
Entity Type:Organization
Organization Name:BAYSIDE FAMILY HEALTHCARE, INC.
Other - Org Name:BAYSIDE FAMILY HEALTHCARE DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:CHARLOTTE
Authorized Official - Middle Name:
Authorized Official - Last Name:TAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:RN,
Authorized Official - Phone:401-295-9706
Mailing Address - Street 1:308 CALLAHAN RD
Mailing Address - Street 2:
Mailing Address - City:NORTH KINGSTOWN
Mailing Address - State:RI
Mailing Address - Zip Code:02852-7739
Mailing Address - Country:US
Mailing Address - Phone:401-295-9706
Mailing Address - Fax:401-295-0920
Practice Address - Street 1:308 CALLAHAN RD
Practice Address - Street 2:
Practice Address - City:NORTH KINGSTOWN
Practice Address - State:RI
Practice Address - Zip Code:02852-7739
Practice Address - Country:US
Practice Address - Phone:401-295-9706
Practice Address - Fax:401-295-0920
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-23
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIACF01503261QC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
RIRG33703OtherMEDICAID
RIDEN01825OtherDENTAL LICENSE
RIDEN01825OtherDENTAL LICENSE