Provider Demographics
NPI:1598723207
Name:BAY AREA PROPERTIES, LLC
Entity Type:Organization
Organization Name:BAY AREA PROPERTIES, LLC
Other - Org Name:DBA BAYCREST VILLAGE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:TERESA
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:WALDROFF
Authorized Official - Suffix:
Authorized Official - Credentials:RN, MS
Authorized Official - Phone:503-595-2810
Mailing Address - Street 1:3959 SHERIDAN AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97459-2834
Mailing Address - Country:US
Mailing Address - Phone:541-756-4141
Mailing Address - Fax:541-756-1049
Practice Address - Street 1:3959 SHERIDAN AVE
Practice Address - Street 2:
Practice Address - City:NORTH BEND
Practice Address - State:OR
Practice Address - Zip Code:97459-2834
Practice Address - Country:US
Practice Address - Phone:541-756-4141
Practice Address - Fax:541-756-1049
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR33203314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR800066Medicaid
OR800066Medicaid