Provider Demographics
NPI:1710122189
Name:BAYHAVEN
Entity Type:Organization
Organization Name:BAYHAVEN
Other - Org Name:BAYHAVEN MASSAGE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/THERAPIST
Authorized Official - Prefix:MS
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:
Authorized Official - Last Name:HALL
Authorized Official - Suffix:
Authorized Official - Credentials:LMT, NMT
Authorized Official - Phone:727-822-8808
Mailing Address - Street 1:PO BOX 35189
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33705-0504
Mailing Address - Country:US
Mailing Address - Phone:727-822-8808
Mailing Address - Fax:
Practice Address - Street 1:1201 4TH ST S
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33701-5223
Practice Address - Country:US
Practice Address - Phone:727-822-8808
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-12
Last Update Date:2008-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA 44842305S00000X
FLMM19938332900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332900000XSuppliersNon-Pharmacy Dispensing Site
No305S00000XManaged Care OrganizationsPoint of Service