Provider Demographics
NPI:1922347574
Name:BAY AREA HEALTH & WELLNESS CENTER, INC.
Entity Type:Organization
Organization Name:BAY AREA HEALTH & WELLNESS CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:CHERYL
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:ALDERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:CEO
Authorized Official - Phone:727-498-6410
Mailing Address - Street 1:6399 38TH AVE N
Mailing Address - Street 2:SUITE B-5
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33710-1647
Mailing Address - Country:US
Mailing Address - Phone:727-498-6410
Mailing Address - Fax:727-498-8615
Practice Address - Street 1:6399 38TH AVE N
Practice Address - Street 2:SUITE B-5
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33710-1647
Practice Address - Country:US
Practice Address - Phone:727-498-6410
Practice Address - Fax:727-498-8615
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-01
Last Update Date:2013-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL06-52-AD-9975-01261QR0405X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder