Provider Demographics
NPI:1134775976
Name:BAYSIDE RECOVERY AND WELLNESS CENTER LLC
Entity type:Organization
Organization Name:BAYSIDE RECOVERY AND WELLNESS CENTER LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO/CLINCIAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MORGAN
Authorized Official - Middle Name:
Authorized Official - Last Name:O'SHAUGHNESSY
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:321-372-6897
Mailing Address - Street 1:1501 ROBERT J CONLAN BLVD NE STE 7
Mailing Address - Street 2:
Mailing Address - City:PALM BAY
Mailing Address - State:FL
Mailing Address - Zip Code:32905-3559
Mailing Address - Country:US
Mailing Address - Phone:321-372-6897
Mailing Address - Fax:321-372-6896
Practice Address - Street 1:1501 ROBERT J CONLAN BLVD NE STE 7
Practice Address - Street 2:
Practice Address - City:PALM BAY
Practice Address - State:FL
Practice Address - Zip Code:32905-3559
Practice Address - Country:US
Practice Address - Phone:321-372-6897
Practice Address - Fax:321-372-6896
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-16
Last Update Date:2021-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation
No324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility