Provider Demographics
NPI:1184143380
Name:GAHC4 BAYSIDE FL TRS SUB, LLC
Entity type:Organization
Organization Name:GAHC4 BAYSIDE FL TRS SUB, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DANNY
Authorized Official - Middle Name:
Authorized Official - Last Name:PROSKY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-270-9200
Mailing Address - Street 1:18191 VON KARMAN AVE STE 300
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92612-7106
Mailing Address - Country:US
Mailing Address - Phone:949-270-9200
Mailing Address - Fax:
Practice Address - Street 1:9381 US HIGHWAY 19 N
Practice Address - Street 2:
Practice Address - City:PINELLAS PARK
Practice Address - State:FL
Practice Address - Zip Code:33782-5410
Practice Address - Country:US
Practice Address - Phone:727-491-5466
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-19
Last Update Date:2017-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility