Provider Demographics
NPI:1578546123
Name:BAYVIEW MANOR LLC
Entity Type:Organization
Organization Name:BAYVIEW MANOR LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:
Authorized Official - Last Name:MAKAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:843-524-8911
Mailing Address - Street 1:PO BOX 1103
Mailing Address - Street 2:
Mailing Address - City:BEAUFORT
Mailing Address - State:SC
Mailing Address - Zip Code:29901-1103
Mailing Address - Country:US
Mailing Address - Phone:843-524-8911
Mailing Address - Fax:843-986-0831
Practice Address - Street 1:11 TODD DR
Practice Address - Street 2:
Practice Address - City:BEAUFORT
Practice Address - State:SC
Practice Address - Zip Code:29902
Practice Address - Country:US
Practice Address - Phone:843-524-8911
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-28
Last Update Date:2007-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC415627Medicaid
SC415627Medicaid
425067Medicare Oscar/Certification