Provider Demographics
NPI:1659015725
Name:BAYSIDE WELLNESS, LLC
Entity Type:Organization
Organization Name:BAYSIDE WELLNESS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:LANGLOIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:231-946-6000
Mailing Address - Street 1:236 1/2 E. FRONT ST.
Mailing Address - Street 2:SUITE 6
Mailing Address - City:TRAVERSE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49684
Mailing Address - Country:US
Mailing Address - Phone:231-946-6000
Mailing Address - Fax:231-946-7000
Practice Address - Street 1:236 1/2 E. FRONT ST.
Practice Address - Street 2:SUITE 6
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49684
Practice Address - Country:US
Practice Address - Phone:231-946-6000
Practice Address - Fax:231-946-7000
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-25
Last Update Date:2024-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health