Provider Demographics
NPI:1760479166
Name:BAYSIDE HEALTHCARE CENTER LLC
Entity Type:Organization
Organization Name:BAYSIDE HEALTHCARE CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:MR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:LABORDE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:985-429-8800
Mailing Address - Street 1:200 W UNIVERSITY AVE
Mailing Address - Street 2:
Mailing Address - City:HAMMOND
Mailing Address - State:LA
Mailing Address - Zip Code:70401-1319
Mailing Address - Country:US
Mailing Address - Phone:985-429-8800
Mailing Address - Fax:985-542-0912
Practice Address - Street 1:3201 WALL BLVD
Practice Address - Street 2:
Practice Address - City:GRETNA
Practice Address - State:LA
Practice Address - Zip Code:70056-7755
Practice Address - Country:US
Practice Address - Phone:504-393-1515
Practice Address - Fax:504-391-7426
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-30
Last Update Date:2008-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA889314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1510912Medicaid
LA19-5309Medicare ID - Type Unspecified
LA1510912Medicaid