Provider Demographics
NPI:1770034563
Name:BAY GROUP HEALTHCARE NORTHWEST
Entity Type:Organization
Organization Name:BAY GROUP HEALTHCARE NORTHWEST
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MAXIM
Authorized Official - Middle Name:
Authorized Official - Last Name:AZAROV
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-551-1222
Mailing Address - Street 1:8569 DOUBLETREE DR N
Mailing Address - Street 2:
Mailing Address - City:CROWN POINT
Mailing Address - State:IN
Mailing Address - Zip Code:46307-9805
Mailing Address - Country:US
Mailing Address - Phone:773-551-1222
Mailing Address - Fax:
Practice Address - Street 1:138 S MAIN ST STE 303
Practice Address - Street 2:
Practice Address - City:CROWN POINT
Practice Address - State:IN
Practice Address - Zip Code:46307-4089
Practice Address - Country:US
Practice Address - Phone:773-551-1222
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-17
Last Update Date:2016-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health