Provider Demographics
NPI:1891243440
Name:BAY CENTRE, INC.
Entity Type:Organization
Organization Name:BAY CENTRE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:WANDA
Authorized Official - Middle Name:H
Authorized Official - Last Name:TAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:MCC
Authorized Official - Phone:850-619-5631
Mailing Address - Street 1:4590 ISABELLA INGRAM DR
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32504-5032
Mailing Address - Country:US
Mailing Address - Phone:850-619-5631
Mailing Address - Fax:850-308-7977
Practice Address - Street 1:4590 ISABELLA INGRAM DR
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32504-5032
Practice Address - Country:US
Practice Address - Phone:850-619-5631
Practice Address - Fax:850-308-7977
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-13
Last Update Date:2016-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH1271101YM0800X
FLSS185103TS0200X
FLMA79472225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchoolGroup - Multi-Specialty
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Multi-Specialty