Provider Demographics
NPI:1023892478
Name:BAYSIDE HOUSING & SERVICES
Entity type:Organization
Organization Name:BAYSIDE HOUSING & SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:GARY
Authorized Official - Middle Name:
Authorized Official - Last Name:KEISTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-385-4637
Mailing Address - Street 1:PO BOX 927
Mailing Address - Street 2:
Mailing Address - City:PORT HADLOCK
Mailing Address - State:WA
Mailing Address - Zip Code:98339-0927
Mailing Address - Country:US
Mailing Address - Phone:360-385-4637
Mailing Address - Fax:
Practice Address - Street 1:310 HADLOCK BAY RD
Practice Address - Street 2:
Practice Address - City:PORT HADLOCK
Practice Address - State:WA
Practice Address - Zip Code:98339-9721
Practice Address - Country:US
Practice Address - Phone:360-385-4637
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-24
Last Update Date:2023-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management