Provider Demographics
NPI:1669697942
Name:BAYSIDE HOSPICE INC
Entity type:Organization
Organization Name:BAYSIDE HOSPICE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ERWIN
Authorized Official - Middle Name:D
Authorized Official - Last Name:REYES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-891-3500
Mailing Address - Street 1:25636 NARBONNE AVE
Mailing Address - Street 2:SUITE C
Mailing Address - City:LOMITA
Mailing Address - State:CA
Mailing Address - Zip Code:90717-2512
Mailing Address - Country:US
Mailing Address - Phone:310-891-3500
Mailing Address - Fax:310-891-1333
Practice Address - Street 1:25636 NARBONNE AVE
Practice Address - Street 2:SUITE C
Practice Address - City:LOMITA
Practice Address - State:CA
Practice Address - Zip Code:90717-2512
Practice Address - Country:US
Practice Address - Phone:310-891-3500
Practice Address - Fax:310-891-1333
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-13
Last Update Date:2010-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA551582Medicare Oscar/Certification