Provider Demographics
NPI:1821433426
Name:BAYSHORE DULUTH MANAGEMENT, LLC
Entity Type:Organization
Organization Name:BAYSHORE DULUTH MANAGEMENT, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ELIEZER
Authorized Official - Middle Name:
Authorized Official - Last Name:DEITSCH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:516-250-1260
Mailing Address - Street 1:7150 PARSONS BLVD STE 1001
Mailing Address - Street 2:C/O PARAGON HEALTHCARE
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11365-4131
Mailing Address - Country:US
Mailing Address - Phone:718-408-8953
Mailing Address - Fax:
Practice Address - Street 1:1601 SAINT LOUIS AVE
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:MN
Practice Address - Zip Code:55802-2442
Practice Address - Country:US
Practice Address - Phone:218-727-8651
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-08
Last Update Date:2013-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility