Provider Demographics
NPI:1700667383
Name:BAY AREA HEALTHCARE ALLIANCE LLC
Entity Type:Organization
Organization Name:BAY AREA HEALTHCARE ALLIANCE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:DESHAE
Authorized Official - Middle Name:
Authorized Official - Last Name:MARTIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-938-0040
Mailing Address - Street 1:2105 ROANOKE SPRINGS DR
Mailing Address - Street 2:
Mailing Address - City:RUSKIN
Mailing Address - State:FL
Mailing Address - Zip Code:33570-6312
Mailing Address - Country:US
Mailing Address - Phone:813-938-0040
Mailing Address - Fax:
Practice Address - Street 1:2105 ROANOKE SPRINGS DR
Practice Address - Street 2:
Practice Address - City:RUSKIN
Practice Address - State:FL
Practice Address - Zip Code:33570-6312
Practice Address - Country:US
Practice Address - Phone:813-938-0040
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-10
Last Update Date:2023-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
No251J00000XAgenciesNursing Care
No253Z00000XAgenciesIn Home Supportive Care