Provider Demographics
NPI:1720566078
Name:BAYFRONT HEALTHCARE SERVICES LLC
Entity Type:Organization
Organization Name:BAYFRONT HEALTHCARE SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARYAM
Authorized Official - Middle Name:NAHAR
Authorized Official - Last Name:RIBADU-JENKINS
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:562-595-8111
Mailing Address - Street 1:324 E BIXBY RD
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90807-3432
Mailing Address - Country:US
Mailing Address - Phone:562-595-8111
Mailing Address - Fax:562-595-8148
Practice Address - Street 1:324 E BIXBY RD
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90807-3432
Practice Address - Country:US
Practice Address - Phone:562-595-8111
Practice Address - Fax:562-595-8148
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-30
Last Update Date:2018-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health